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PRACTICAL OBSERVATIONS 



ON SOME OF THE DISEASES OF 



THE RECTUM, ANUS 



AND 



CONTIGUOUS TEXTURES; 



GIVING 



THEIR NATURE, SEAT, CAUSES, SYMPTOMS, CONSEQUENCES, 
AND PREVENTION: 



ESPECIALLY ADDRESSED TO THE NON-MEDICAL READER. 
BY W. BODENHAMER, M. D. 



" To preserve health is a moral and religious duty ; for health is the basis of all social vir- 
tues : we can be useful no longer than while we are well " — Dr. Johnson. 



SECOND EDITION. 
ILLUSTRATED BY PLATES, AND EXEMPLIFIED BY NUMEROUS CASES. 



NEW YORK : 
PUBLISHED FOR THE AUTHOR, BY J. S. REDFIELD, 

34 BEEKMAN-STREET. 
1855. 






*v 



Entered according to act of Congress, in the year eighteen hundred and fifty-five, 

By J. S. REDFIE LD, 

In the Clerk's Office of the District Court of the United States, for the Southern 

District of New York. 



PREFACE TO THE FIRST EDITION. 



The object of the present work is simply to call the atten- 
tion of the non-medical reader to a class of diseases of most 
frequent occurrence, and which, as a general rule, are but. 
very imperfectly understood by him ; diseases too, to which 
he is daily liable, or from some one of which he is already 
suffering. This work will point out in a concise, plain and 
familiar manner the exact location of each disease ; its nature, 
its principal causes, its most prominent symptoms, the evil 
consequences of procrastinating its proper or judicious treat- 
ment, as well as the numerous, inefficacious and often 
extremely dangerous, painful and cruel methods which are 
at the present day advocated and adopted for its relief. This 
information will enable the general reader to avoid the causes 
of those diseases, and thus to remain free from their annoy- 
ance ; and it will also enable him, should he be so unfortu- 
nate as to be afflicted with any of them, to guard against 
the vile practices of the ignorant and presumptuous empiric, 
as well as, to shun the unnecessary, the cruel and dangerous 
operations of the scientific surgeon, commonly so called ; but 
often in reality, nothing more than the mere operator. 

The many works already written upon this subject, are by 



\\ v 



PREFACE TO THE FIRST EDITION. 



no means suitable for the especial and beneficial study of the 
unfortunate sufferer himself. These works were especially 
written for the profession, are very diffuse and abound in 
technicalities, all of which is highly important and very 
interesting to the accomplished surgeon, but afford but very 
little practical information to the general reader. Indeed 
they are almost entirely destitute of that essential and prac- 
tical knowledge which those require who are anxious to avoid 
the causes of those diseases, as well as those whose health 
and happiness have been more or less sacrificed to the rava- 
ges of them. Such is now the rapid diffusion of knowledge 
of every kind, both scientific and general, among all classes 
of persons, that but few can be found who would not be 
desirous to read something which they could at once under- 
stand and appreciate, in relation to this important subject. 

For omitting the treatment of those diseases in the present 
work, some may be disposed to censure the author ; but he 
would remark that he is decidedly opposed to u publishing 
cures for the multitude." Too many works of this class are 
already in existence, for the good of the community at large. 
The instruction they need, is how to preserve their health. 
Books giving such instruction, are real acquisitions. When, 
however, they do become sick, it is then the especial and 
exclusive province of fhe physician to restore them to health. 
The object of the work has already been stated : it is, simply 
to instruct in the first place all who are willing to be 
instructed, how they may prevent those affections. This is 
of the greatest importance ; for the reader should never for- 
get that it is much easier to prevent disease than to cure i* ; 



PREFACE TO THE FIEST EDITION. 

that " an ounce of preventive is worth more than a pound of 
cure.'" The prevention of disease should, therefore, be the 
first consideration of the community at large ; for no indi- 
vidual, however uninformed he may be, but can by proper 
instruction be taught with certainty how to anticipate and 
prevent disease 

The author would again remark that another reason for not 
giving the treatment of those diseases in this work, is that 
they are difficult to treat under the most favorable circum- 
stances, and he presumes, therefore, that none would desire 
or attempt to treat them, who do not possess the indispensa- 
ble pre-requisite, a complete knowledge of their pathology, 
as well as a complete knowledge of the anatomy and physi- 
ology of the parts concerned. Without this, none can treat 
them with discrimination and success, and this kind of 
knowledge is not to be obtained from books alone ; it is by 
minute dissections of the parts, and by attending patients 
suffering from those maladies, that the surgeon can ever 
acquire that .quickness, that peculiar tact, and that experi- 
ence which alone can render him able and skillful in their 
treatment. 

The late and lamented Doctor James Johnson, of London, 
in his valuable treatise on Derangements of the Liver, makes 
the following very just and pertinent -remarks on this sub- 
ject : — " These are," says he, " the glorious fruits of that wide 
system of charlatanism which pervades these islands, and 
which must prove as strong ' a preventive check? to popula- 
tion as the statistical philosopher can desire ! It is on this 
account, I have been solicitous to portray the causes of dis- 






6 PREFACE TO THE FIRST EDITION. 



ease as beacons to general readers ; but to attempt to teach 
them how to use the remedies, when they are actually over- 
taken with illness, would be to furnish them with the letters 
of Belleropiion, for their own destruction ! " 

"Some good and much harm are every day done by the 
family medicine chest, and patent medicine warehouse. If 
the experienced physician is often at a loss what to prescribe, 
and frequently finds it most prudent to prescribe nothing at 
all, what infinite mischief must be hourly produced by the 
patient, and the still more ignorant quack, pouring drugs of 
which they know little, into a body of which they know less ! 
The dictionaries of popular medicine, and gazettes of health 
slay annually their thousands ; not directly, by the actual 
injury of the remedies which they congregate without knowl- 
edge or discrimination, but eventually, by procrastinating the 
interference of the regular practitioner till the period of cure 
is past, or until the disease has taken that hold on the consti- 
tution or part, which will baffle all future remedial means." 

The following medico-legal opinion on this subject, may be 
in place here : — 

A person once observed to an eminent lawyer, that 
" Buchanh Domestic Medicine" was a good book, because it 
qualifies every man to be his own physician. How far that 
may be the case, observed the man of law, I will not presume 
to determine ; but I may be allowed to speak decidedly as to 
my own profession, and so I hesitate not to pronounce, that 
every man who is his own lawyer, has a fool for a client. 

The author has addressed this small work in an especial 
manner to the general reader, rather than to the profession, 



^ 



PREFACE TO THE FIRST EDITION. 7 

for the reason that medical men generally, can scarcely ever 
be induced to examine, adopt or introduce any practice 
which in the least conflicts with their own, unless the public 
are in the first place impressed with the importance of it. 
As soon as the public understand the subject well, and appre- 
ciate the importance of it, then and not till then, will the 
profession wheel into rank. Hence it is the policy of the 
author to address the public first, and afterwards the pro- 
fession. 

Such a work as is here attempted, the author is well con- 
vinced, from extensive observation, to be very much needed 
by the general reader. Whether this will therefore, com- 
pletely supply the desideratum, will be for those to deter- 
mine for whom it was written. 

It may not be improper here also to remark, that it is the 
design of the author, at no distant day, to present also to the 
profession a complete practical work on the diseases of the 
Anus and Rectum, which will contain all that relates to the 
subject, from the earliest ages, down to the present period, 
together with the results of his own experience. The work 
to be illustrated by numerous colored plates, and exemplified 
by a very large number of cases. 

Were the author disposed to make an apology for the 
many imperfections of this little work, he would remark that 
it was written at intervals, " snatched" from professional 
engagements, during the months of July and August. 

Louisville, September 30th, 1846. 



PREFACE TO THE SECOND EDITION. 



The first edition of this work was issued from the press 
seven years ago, and the author does not now deem it neces- 
sary to trouble the reader with many prefatory remarks. 
The work has neither sought nor obtained any other patron- 
age than the approbation of those to whom it was addressed. 
This it has obtained. The present edition is much improved 
in many respects, the addition of the plates not being among 
the least of its improvements. 

In consequence of the author having devoted his special 
attention to the medical and surgical treatment of the dis- 
eases named in this work, he has been subjected to much 
unjust and unmerited abuse from many of the profession. It 
appears, in this country, that whenever a surgeon or physi- 
cian, without any regard whatever to his surgical or medical 
ability, acquirements or standing, commences to practice 
any speciality, he is at once denounced by his brethren as a 
quack, an empiric, sl mere specialist, &c. Now, such a course 
of opposition, to say the least of it, is very illiberal, very 
unjust, very unkind ; but it doubtless has arisen mainly from 
the fact that so many are practicing specialities, in the 
United States, who are entirely destitute of any medical 



preface" to the second edition. 9 

education ; or, indeed, education of any kind. In Europe, 
some of the most eminent of the profession are engaged in 
the practice of specialities, and they are universally consid- 
ered superior in their profession. The truth is, that the most 
important, and the most valuable results have been effected 
by such concentration of thought, of purpose and of practice 
upon one particular point ; it tends greatly to increase the 
stock of pathological and physiological knowledge ; and by 
improving a part, it leads to the gradual perfection of the 
whole. 

Civilization, with its accompanying increase of wealth and 
population, is universally followed by the minute division of 
labor, and the rendition into fragments of the pursuit of 
every art and science. The science of medicine, which em- 
braces all that relates to the human organization and its 
injuries, has not escaped this universal law; having been at 
an early period divided into two grand divisions — medicine 
and surgery / and these again, at the present day, subdivided 
into almost as many parts as there are maladies. This state 
of things, in the medical profession, is productive of much 
good, provided the surgeon or physician practicing any one 
branch, has, in the first place, that general knowledge and 
scientific attainment which are always absolutely necessary 
for the efficient practice of medicine in its most comprehen- 
sive sense ; for, without this general knowledge, he can; 
never succeed in the practice of any one particular branch.. 
To render himself competent, he requires not only a regu- 
lar education, and a general knowledge of the various 
branches of medical science, but engrafted upon this,, a. 



10 PREFACE TO THE SECOND EDITION. 

minute, accurate professional knowledge of the particular 
branch of medicine or surgery which he practices. That 
branch of surgery, for instance, to which the author gives 
his attention, calls into exercise all our anatomical, all our 
physiological, and all our surgical knowledge ; indeed, it is a 
speciality which embraces the whole body, and a scientific 
knowledge of the treatment of those diseases will be a means 
of greatly improving surgery in general. 

After a successful practice of about eighteen years in the 
treatment of the diseases mentioned in this work, it will not 
be deemed necessary for the author to stand forth and defend 
his peculiar method here ; this will be done before the pro- 
per tribunal — the profession, in his large forthcoming work. 
He places his claims for support upon something more tan- 
gible than mere assertions, and refers, not without a strong 
feeling of pride, to the many evidences in the South and 
South-west where he has resided, and to the many proofs 
adduced in this work. 

In conclusion, he returns his most grateful thanks to his 

numerous patrons and friends, at whose hands, for so long a 

time, he has received so many favors, and to whose service 

he is still ready to devote the remainder of his days. 

Saint Nicholas Hotel, ) 

New York, Dec. 1, 1854. \ 



CONTENTS 



Page 
Introduction 7 , - 15 

CHAPTER I. 

WHY ARE ANAL AND RECTAL DISEASES, NOW, OF SO MUCH MORE FREQUENT 
OCCURRENCE THAN THEY WERE FORMERLY ? 

The increase of anal and rectal affections, and the causes. The abuse of pur- 
gative medicine and its evil consequences ; Quaiu's case of death from 
excessive purgation induced by Morrison's pills ; the Southern gentleman 
and Brandreth's pills ; Physic ! Physic !! Physic !!! the motto of most all 
the quacks, for the cure of all diseases ; nostrums and patent right medi- 
cines ; the unity of disease and the unity of remedy, a most pernicious 
doctrine, and generally adopted by all quacks ; the popularity of this doc- 
trine among the masses, and the causes why it is so ; Dr. Flint on the 
abuse of purgative medicine ; tight lacing and its evil consequences 21 

CHAPTER II. 

STATISTICS. 

The difficulty of obtaining correct statistics ; the causes of this difficulty ; 
interesting statistics relative to fistula in ano; the celebrated Peter de 
March etti is said to have cured above six hundred cases of fistula by the 
knife, caustic, and the red-hot iron ; the Author has cured upwards of seven 
hundred cases of fistula in ano, in seventeen years, without either the knife, 
the actual or potential cautery 26 

CHAPTER III. 

THE ANATOMY OF THE RECTUM AND ANUS. 

The position, form, capacity, calibre, attachments, division and structure of 
the rectum ; the three coats of the rectum ; the peritoneal, the muscular, 
and the mucous coat ; the longitudinal and circular fibres of the muscular 
coat ; the mucous glands and absorbent vessels of the rectum ; the arteries, 
▼eins and nerves of the rectum; the anatomy of the anus ; the two sphinc- 
ter ani muscles ; their important office ; the great importance of a know- 
ledge of the natural as well as morbid action of these two muscles 28 

CHAPTER IY. 

THE PHYSIOLOGY OF THE RECTUM AND ANUS. 

The rectum is the terminal depot of the intestinal canal for the reception of 
the faecal matter ; the utility of the peculiar position and form of the rec- 
tum ; its peristaltic, or worm-like motion ; the call of nature ; the process 
of defecation ; the peculiar nervous endowment of the rectum ; the act of 
defecation under the control of, or in obedience to the will ; the frequency 
of this act ; its uncertainty and causes ; should, as a general rule, take 
place once, daily ; the evil consequences when longer delayed ; it gene- 
rally takes place in the morning ; and the causes 36 



12 CONTENTS. 

Page 
CHAPTER V. 

CONSTIPATION. 

Constipation a fruitful source of numerous diseases. The common causes ; 
want of attention to the calls of nature ; evil consequences of neglecting 
them ; want of proper accommodations for relieving the bowels a frequent 
cause of constipation ; water-closets and cabinets d'aisance. Peculiarities 
respecting the action of the bowels in some persons. The prophylactic 
treatment of constipation. Daily visiting the water-closet. Enemata ; 
their use and abuse ; proper instruments for administering them ; exercise ; 
diet ; brown bread and the antiquity of its use by different nations ; ripe 
fruits, and when they should be eaten , broiled bacon ; mustard seed ; 
bran ; cold water ; friction of the abdomen ; early rising 41 

CHAPTER VI. 

HAEMORRHOIDS PILES. 

Vast numbers suffering from this disease ; description and symptoms of 
piles ; bleeding from piles; extraordinary cases of haemorrhage from piles; 
should this disease be radically cured in every iostance ? medical treat- 
ment of piles generally empirical; surgical treatment alone to be de- 
pended upon for a complete and radical cure ; superstitious treatment of 
haemorrhoids : excision and cauterization by knife, scissors, caustics and 
red-hot iron ; objections to these methods ; fatal cases by excision with 
the knife, reported by Sir A. Cooper; spontaneous cure of piles; the case 
of the celebrated Home Tooke; concluding remarks; letters from per- 
sons afflicted with piles, and from persons cured of piles 58 

CHAPTER VII. 

FISTULA IN ANO. 

This disease noticed by Hippocrates, Celsus, Galen, <fec. ; Astruc and Dionis 
relate an interesting circumstance relative to this disease ; the case of 
Henry V. and Louis XIV. ; the complete history of the latter case as given 
by Dionis ; definition of the term fistula ; description, classification, forma- 
tion, causes, and symptoms of fistula ; who are the victims of fistula ? 
Objectionable methods of treating fistulae ; incision and excision by the knife ; 
cauterization by the heated iron and by caustic ; the erroneous opinions 
which led to the adoption of these methods ; the knife operation the most 
fashionable method ; the indications of this operation as contended for by 
the moderns ; the falsity of these; the true indications pointed out; serious 
objections to the knife operation ; the method by caustics or escharotics ; 
the autiquity of this method ; the objections to the caustic method ; (ho 
method by apolinose or ligature as ancient as surgery itself ; objections to 
the ligature as used by both the ancients and moderns; improvements 
made by the author in the use of the ligature ; the peculiarities of his 
method ; Dr. Luke's method by ligature ; natural cure of fistula ; letters 
from persons afflicted with fistula ; publications and letters from persons 
cured of fistula, &c 97 






CONTENTS. 13 

Page 
CHAPTER VIII. 

ABSCESS NEAR THE RECTUM AND ANUS. 

Description of anal and rectal abscesses ; the causes and symptoms of these ; 
numerous foreign bodies removed from such abscesses ; a warning to per- 
sons what they swallow ; desperate cases cured ; letters from persons 
cured, and from those having the disease * . . 168 

CHAPTER IX. 

COMPLICATION OF ANAL ABSCESS, OR FISTULA ANI, WITH PHTHISIS PULMONALIS. 

Explanation of the connection between consumption and anal abscess and fis- 
tula ; the opinions of Laennec, Bordeu, Andral, Lewis, and Clark ; Dr. 
McDowell's letter to the author on this subject ; the author's answer to 
the important question, should persons having this complication ever be 
cured? important cases cured; letters from persons laboring under this 
complication ; worst kind of advice ; death from procrastination 177 

CHAPTER X. 

FISSURE OF THE ANUS. 

Description of anal fissure ; the causes and symptoms of anal fissure ; the 
popular method of treating this painful disease ; objections to this method ; 
letters from persons afflicted with anal fissure ; persons cured of this tor- 

menticg disease by the author 183 

CHAPTER XI. 

PROLAPSUS OF THE RECTUM. 

Description of prolapsus recti ; causes of falling of the bowel ; how to dis- 
tinguish this disease from piles ; the importance of this distinction : the 
common method of treating this disease ; objections to this method ; let- 
ters from persons afflicted with this troublesome and painful disease. 192 

CHAPTER XII. 

ULCERATION OF THE RECTUM, 

Description of ulceration of the lower bowel; appearance of the ulcers; 
causes and symptoms of this disease ; 'ulceration of the rectum difficult to 
cure ; the causes of this difficulty ; letters from persons having this disease. 198 
CHAPTER XIII. 

INFLAMMATION AND EXCORIATION OF THE ANUS. 

The causes and symptoms of this disease ; how to cure it, and how to avoid it. 203 
CHAPTER XIV. 

PRURITUS (ITCHING) OF THE ANUS. 

The description, causes, and symptoms of this rebellious affection ; should 
this disease ever be cured ? Dr. Lettsome's opinion ; to treat it with suc- 
cess, the cause of it must be well understood 205 

CHAPTER XV. 

EXCRESCENCES OF THE ANUS. 

The description and appearance of vegetations, or warty tumors of the anus ; 
fanciful appellations given to them by the ancient Greek, Latin, and 
Arabic authors ; causes of this disease ; cases cured 207 



14 CONTENTS. 

Page 
CHAPTER XVI.. 

POLYPUS OF THE RECTUM. 

The term polypus, why used by surgeons to designate this kind of tumor ; 
this disease considered uncommon by authors generally ; the author dif- 
fers from this in opinion ; the number of cases treated by him ; the descrip- 
tion, causes, and symptoms of polypoid tumors of the rectum ; diagnosis, 
or how to distinguish rectal polypi : spontaneous cure of this disease ; let- 
ters from persons afflicted with this affection 209 

CHAPTER XVII. 

NEURALGIA OF THE ANUS. 

Definition of the term neuralgia ; it is a most agonizing disease ; Mons. Vel- 
peau's description of it ; causes and symptoms of anal neuralgia ; five cases 

treated by the author ; Dr. Bushe's description of a case.. 211 

CHAPTER XVIII. 

SPASMODIC CONTRACTION OF THE SPHINCTER AKL 

The description, nature, causes and symptoms of this painful disease ; it 
resembles fissure of the anus ; the common treatment of it, is division of 

the sphincter ani muscles ; no necessity whatever for this operation 221 

CHAPTER XIX. 

ORGANIC STRICTURE OF THE ANUS. 

Description, causes, and symptoms of this serious disease ; cases cured by 
the author 223 

CHAPTER XX. 

STRICTURE OF THE RECTUM. 

This disease is considered by some the golden egg of the quacks - it is diffi- 
cult to treat successfully ; diversity of opinion with regard to the situation 
of rectal stricture ; description of this disease ; symptoms ; Dr. Bushe's 

description ; cases cured by the author 226 

CHAPTER XXI. 

MALIGNANT DEGENERATION OF THE RECTUM. 

Description of this dreadful malady ; causes and symptoms ; the diagnosis 
sometimes difficult ; the pretensions of empirics regarding the cure of can- 
cer ; excision of the anal canal ; objections to this outrageous operation ; 

cases seen and treated by the author 233 

CHAPTER XXII. 

FISTULA IN PERIN.EO— URINARY FISTULA. 

A description of this disgusting disease ; the causes and symptoms ; the popu- 
lar treatment: objections to this ; cases cured by the author; letters from 

persons having this disease 241 

CHAPTER XXIII. 

VAGINAL FISTULA. 

A most distressing disease ; divided into vesico-vaginal, ure thro -vagi oal and 
recto-vaginal ; description of vaginal fistula ; causes ; some objection- 
able methods of treating vesico-vaginal fistula ; most difficult to cure ; a 
case cured by the author ; a number of cases of recto-vagiual fistula cured 
by the author 248 



INTRODUCTION. 



The diseases incidental to the Anus and Kectum, or Lower 
Bowel, are of frequent occurrence among all classes of per- 
sons, and in consequence of their seat, as well as their nature, 
are perhaps the occasion of more suffering and of more 
annoyance to the patient, than with few exceptions, any- 
other class of diseases. Of extreme frequency, we know of 
none more difficult to treat successfully, we find none per 
haps less generally understood, and none certainly, in which 
a rational treatment is more necessary. Who will attempt 
to affirm that they are as well understood as they should be, 
or that they have been studied and treated with that care 
and discrimination which their importance demands ? Such 
is the ignorance on this subject, even in the profession, that 
a very able medical reviewer has observed that, " beyond the 
treatment of Fistula in Ano and Haemorrhoids, {piles,) the 
surgery of the rectum and ovnus is a sort of land of the Cim- 
merians, where quacks alone can breathe, and humbug darkens 
the air." But are not those diseases just as susceptible as any 
others of exact observation, of scientific analysis, and of safe, 
mild and appropriate treatment ? Is it indeed impossible for 
light ever to dawn upon this region, darkened by humbug 
and inhabited by quacks ? 



16 INTRODUCTION". 

Did surgeons but devote half the time and attention to this 
class of diseases, which they bestow upon some others of less 
importance, and did patients consult none but those whom 
they positively knew to be qualified, quackery, in these 
instances, would at once cease, and Messrs. Humbug, that 
large and flourishing Firm, would soon be compelled to 
close doors. 

The great incertitude which characterizes the medical as 
well as the surgical treatment of those diseases, and which 
continually manifests itself in alternate timidity and cruelty 
of practice, is caused by the erroneous, the conflicting, and 
the arbitrary or dogmatic opinions which to so great an 
extent still 'prevail concerning their true character and treat- 
ment. It is, therefore, a matter of no surprise that so many 
patients afflicted with those affections, fall into the hands of 
empirical, unprincipled, or reckless practitioners, whose 
deceptions are favored by the mystery and secrecy arising 
from their situation ; and who are thereby encouraged and 
emboldened to perform and to repeat, painful, dangerous and 
unnecessary operations ; or to apply the most severe and often 
worse than useless applications. 

The delicate situation of those diseases forms an almost 
insurmountable obstacle in the minds of many patients, 
especially if they are females, to seek and to obtain relief; 
and even when they do seek it, there is often nothing pre- 
sented to their choice, but the formidable operations of the 
surgeon on the one hand, or the multitudinous nostrums of 
the quack on the other ; hence they are too often induced by 



INTRODUCTION. 17 

these several causes to postpone, from time to time, the 
proper treatment of their maladies until it is often too late. 

The truth is, too little attention is paid to those affections, 
both by physicians and patients, and they are in this respect 
often, both to blame. Physicians are too apt, after hearing 
their patients describe their sufferings in the anal region, to 
treat them lightly by merely replying, " 0, it is nothing hut 
the piles, /suppose, you will he well in a day or two,' 7 &c, 
and then prescribing some salve merely. In most all such 
cases, a minute examination should be made, for two chances 
to one, if some serious disease, or complication will not be 
found to exist. The reasons, however, why this is not done 
are obvious. An examination is not a very pleasant thing, 
either to the surgeon or to the patient. But if the surgeon 
consults his own reputation, or the welfare of his patient, he 
will insist on an examination, especially when positive symp- 
toms are complained of, or when suspicious ones, not other- 
wise well accounted for, do exist. 

" It would be useless," says a fine writer, " to dwell on the 
necessity of the surgeon being thoroughly acquainted with 
these painful maladies. Their distressing nature weighs 
heavily on a patient's comfort and repose of mind, and he 
anxiously seeks for relief at the hands of science ; but too 
often he does not obtain it. How then can a physician or 
surgeon practice with a clear conscience, who does not keep 
himself on a par with the knowledge of the age. In other 
professions, ignorance may be folly ; in ours, it is crime. 77 

In consequence of these various considerations and of the 
fact that these diseases prevail to a considerable extent, 



18 INTRODUCTION. 

especially in the South and South-west, the author was 
induced to turn his attention directly to them, and some 
eighteen years have placed under his immediate care and 
observation a very large number of patients, both male and 
female, from the different states of the Union ; many of these 
having previously undergone treatment by some of the best 
surgeons of our country. He has devoted these eighteen 
years almost exclusively to the treatment of those diseases, 
to their investigation anatomically, pathologically and physi- 
ologically, and having resided in Louisville, Ky., and New 
Orleans, La., his opportunities for observation and experi- 
ment, have been ample, and he has not failed to avail him- 
self of every source of information within his reach. He has 
consulted and studied with great care all the authorities on 
this subject, both ancient and modern — both European and 
American. Although the labor in this field of investigation 
is by no means inviting or pleasant, but rather repulsive and 
disgusting, yet it must be admitted by all to be highly impor- 
tant ; for upon it, the life, health, comfort and convenience 
of so many, so much depend. No subject, however, should 
be considered degrading or unworthy of anxious attention, 
which involves such serious consequences, or which has for its 
object the improvement of the healing art, or the extension 
of our knowledge of nature's operations. No standard is 
known by which to determine the respectability of any branch 
of the medical profession, than its capacity of saving life and 
suffering, and exciting the powers of the understanding. This 
subject is now beginning to attract the attention of the most 
eminent of the profession, and the author knows of none in 



INTRODUCTION. 19 

the whole compass of medicine and surgery, possessing more 
practical importance or scientific interest. 

It is admitted by all practical surgeons, that those diseases 
are difficult to treat, under the most favorable circumstances. 
Any attempt, therefore, at the diminution of that difficulty, 
should be meritorious, and any degree of success attending 
it, should be a subject of congratulation. Although the 
author does not in the present work give his peculiar method 
of treating those diseases, for reasons already stated, he nev- 
ertheless refers with pleasure to his triumphant success in 
their treatment, as furnishing the most satisfactory and incon- 
testable evidence of its superior excellence. He, however, 
holds no secrets on this subject; but will most cheerfully at 
any time, until his large work appears, communicate his 
method most freely to any regular physician or surgeon who 
should feel so much interest in it, as to be induced to call 
on him. 






PRACTICAL OBSERVATIONS, ETC. 



CHAPTER I. 

"Why are Anal and Rectal Diseases now of so much more 
frequent occurrence than they were formerly 1 

That those affections in the United States have of late 
years greatly increased in their ratio, is a fact confirmed by 
the experience of the oldest and best physicians and surgeons 
of our country. The causes of this increase are obvious, and 
all who will investigate this subject as I have done, will 
come to the same conclusion. 

The Abuse of Purgative Medicine. 

This is one of the most common causes of those diseases at 
the present day. The idea that it is either necessary to obvi- 
ate constipation of the bowels, or on every slight indisposi- 
tion, to swallow some of the numerous and various drastic 
purgative nostrums which literally fill our country, is a popu- 
lar error, and a source of incalculable mischief. It has laid 
the foundation of some of the most serious diseases of the 
lower viscera. The habitual use of such medicines to obvi- 
ate constipation, I repeat, is the cause of more diseases of 
the anal region, than any other one cause that has come 
under my observation. I have ascertained to a certainty, 



22 ABUSE OF PURGATIVE MEDICINE. 

that in one half of the cases I treat for such diseases, the 
cause can be traced to this origin. 

The continued exhibition of such medicines, inflicts much 
reckless and unnecessary injury, by the undue and perni- 
cious excitement of the whole intestinal canal which is thus 
induced, and all for the purpose merely of emptying the 
rectum and forcing the dilatation of the anus, which, after 
all, are accomplished at the expense of the intestinal fluids 
and the softening and the washing out of the excrementi- 
tious matters. In all such cases, a proper attention to 
diet, to exercise, and to the occasional use of an enema of 
cold water, or flaxseed tea, would obviate the difficulty with- 
out inflicting any injury whatever. It is, however, by no 
means easy to convince some people that such medicine can- 
not safely be made use- of as a substitute for moderation in 
diet, for pure air and the proper exercise of the whole mus- 
cular system. In short, for all the natural measures which 
long experience has shown to be necessary for the preserva- 
tion of health. They sometimes experience much relief, — 
much comfort from the operation of the medicine, especially 
after having suffered for several days from constipation ; but 
this immunity from discomfort, is but transitory and decep- 
tive. The ssrme difficulty soon returns with increased force, 
and the same remedy must again be resorted to, and in order 
to produce the same effect, must either be increased in quan- 
tity or in strength at each repetition. It is the pleasant feel- 
ing or the exhilaration which is often experienced by this 
class of invalids, immediately after the free operation of pur- 
gative medicine, which induces them to repeat the same on 
each and every recurrence of the constipation or indisposi- 
tion. 

" A few years ago," says Quain, in his work on diseases of 
the rectum, " a case came to my knowledge which will 
serve to illustrate the baneful influence of the habit of using 



TESTIMONY OF DR. FLINT. 23 

purgative medicine. The commander of a merchant vessel, 
a person of robust frame and much ability in his profession, 
began to take Morrison's pills to relieve constipation of the 
bowels, at sea. Continuing the use of the medicine, he 
became in time reduced to extreme debility from constant 
purging. At length the appetite grew by what it fed on, to 
such an extent, that when confined to his bed from mere 
weakness, and unable to swallow the pills whole, the unhappy 
man had them bruised in a mortar, and took them with a 
spoon. He died of the drug." 

Several years since, a gentleman from one of the southern 
States consulted me for a fistula in ano which caused him 
intense suffering. He stated that for a year or two previous 
to the formation of the fistula, he could never have an evac- 
uation from his bowels without swallowing great quantities 
of Brandreth's pills ; that he frequently took as many as 
thirty, forty, and even fifty at one dose. " And," said he, 
" when they did commence to work, they would operate like 
a saw milV This is but one example out of hundreds that 
I might give to demonstrate the injurious effects of this per- 
nicious practice. 

The motto of most all the quacks of the present day, for 
the cure of all diseases, is Physio! Physic!! Physic!!! 
Purgative medicines are good in their proper place, but to 
purge for every thing is absolutely absurd ; therefore, all 
such drastic purgative nostrums, in the form either of pills, 
bitters, or any thing else, should be eschewed as the Cholera.* 

* Since the text was written, I have read with much pleasure, the following 
remarks of Dr. J. B. Flint, of Louisville, Ky. They will be found in the form of 
a note, in his valuable edition of Druitt's Surgery, page 446. Phil. Ed.,- 1846. 
I was much gratified to perceive, that his and my own views so fully harmonize. 
The subject is of great impoitance, and has been too much overlooked by medical 
men ; and I am highly pleased that the Doctor has so ably and so justly spoken 
on it. The note is given entire : — 

' k Nothing has been more remarkable, in my surgical experience in the wes,t, 



24: PATENT MEDICINES. 

Nearly all trie nostrums or patent-right medicines which 
now fill the shelves of our drug shops, are founded, by their 
authors, upon the principle that disease is a unit ; that there 
is but one general cause of disease, arid but one general 
remedy, and that is always certain to be their own infallible 
and peculiar one ; hence their " cure alls" their panaceas, 
Mood purifiers, elixirs of life, &c, in the form of pills, hit- 
ters, sarsaparilla syrups, &c. &c. It is surprising how pop- 
ular this theory is among the masses, and even among 
physicians. Those minds which are but superficially informed 
and unaccustomed to the slow and gradual progress ot 
inductive science, are readily seduced and captivated by the 
reasoning of those who advocate this pernicious system ; and 

than the disproportioned frequency of diseases of the rectum and adjacent tex- 
tures — fistula, piles, prolapsus, &c, and I advert to the fact chiefly for the pur- 
pose of adding a cautioning remark respecting the causes of it. Doubtless it is 
partly to be referred to the chafing and contusions, incident to horse-back riding, 
which is a much more common mode of travelling here, than at the east ; but it 
is mainly attributable to the habit of indiscriminate and excessive purgation, so 
prevalent both as a remedial and prophylactic measure. 

" A large portion of the practitioners of the valley of the Mississippi, have 
been educated under a system of medicine whose theory regards portal conges- 
tion and hepatic derangement, as the essential elements of all diseases, and whose 
practice consists, almost exclusively, in the exhibition of drastic purgatives. 

" It is natural that the people should imitate the therapeutics of their medical 
advisers, when so simply and easily applied ; accordingly they are as much in the 
habit of drenching themselves, and teasing the alimentary canal, on every occasion 
of illness, with some concentrated purgative in the form of pills. 

"Under one of the most constant laws of irritation in mucous canals, the ter- 
minating portions of the apparatus of defecation, are thus perpetually suffering 
under propagated, as well as direct stimulation, and reacts in the various forms of 
disease under notice. Besides these direct mischiefs, and others, involving the 
health in other ways, occasioned by the pernicious doctrines referred to — which 
are indeed in themselves essentially empirical — they encourage the grossest spe- 
cies of quackery, by promoting the consumption of vast quantities of patent pills, 
and other purgative nostrums. 

" In proportion as a more rational pathology shall prevail among physicians, the 
habits of the population will undergo a corresponding change, and the preponder- 
ance of diseases of the rectum in the duties of the surgeon, may be expected to 
disappear accordingly." 



TIGHT LACING. 



25 



this, after all, is not so much to be wondered at, when we 
take into consideration the great apparent simplicity of their 
views of disease — that it is nothing more nor less than " im- 
purity of the Mood," "venous congestion" or some other 
equally fallacious dogma ; and their practice too, being so 
simple, that it can be summed up in as many letters or words 
as will make up the name of one of their own nostrums. 

The mischievous system, founded upon the principle of 
the unity of disease and the unity of remedy, is now advo- 
cated and adopted by quacks of all grades, both in, as well 
as out of the profession, and is the great giant that prostrates 
at once all Medical Colleges, with the head-aching studies of 
Anatomy, Physiology, Botany, Pharmacology, Chemistry, 
&c. It closes all the avenues to progress, and is the burial- 
ground of all improvement, in the noble and dignified science 
of medicine. 

Tight Lacing. 

This is another cause of the increase of anal and rectal 
diseases in modern times. By this practice, all the viscera 
of the abdomen suffer. The function of the liver is impeded, 
the stomach is compressed, and the result is indigestion, with 
all its train of evils on the lower viscera. The rectum, as 
well as the womb and bladder, are forced down much lower 
than natural, from which often result the very worst conse- 
sequences. 

To these causes might be added many more, which tend to 
increase' the list of such patients, but I deem these sufficient 
for all practical purposes. 



OHAPTEE II. 

STATISTICS. 

From the very nature of the diseases of which I am treat- 
ing, and their causes, it is very difficult to obtain available 
data, as there are scarcely any means of arriving at any thing 
like the exact number of such cases that really do exist. A 
very large number, doubtless, of both male and female, but 
especially the latter, never apply for relief ; being deterred 
by the idea that it is absolutely necessary to submit to some 
formidable surgical operation, as is the popular practice of 
the day, in such cases ; or they endeavor, from a false 
delicacy or some other cause, to conceal their disease. I am, 
therefore, not yet prepared to make out an available report, 
or to give full and satisfactory answers to the following 
questions : 

What is the ratio of persons laboring under those diseases, 
to the entire population ? 

Are particular classes more liable to be affected than 
others ? 

What influence has climate in the production of those dis- 
eases ? 

Are they more prevalent in males than in females ? 

I will, however, give the result of my own practice in the 
treatment of fistula in ano, the second most common of this 
class of diseases. From the first of July, 1837, to the first 
of September, 1846, I treated of this one disease alone three 
hundred and five cases. Of this number 275 were whites ; 



STATISTICS. 27 

and 30 were blacks ; 225 were males and 80 were females ; 
of the 225 males, there were 4 boys under three years old ; 
of the 80 females, there were 3 girls under four years old ; 
of the 30 blacks, 26 were males, and 4 were females. The 
blacks were all adults. Of the 196 adult white males, there 
were 74 farmers and agricultural laborers ; 41 mechanics of 
various kinds ; 20 merchants ; 12 clerks ; 10 judges and law- 
yers ; 9 clergymen ; 6 physicians ; 5 sheriffs ; 5 gentlemen 
without professions ; 4 steamboat engineers ; 3 steamboat 
captains ; 3 school teachers ; 2 stage drivers ; 1 hotel keeper, 
and 1 sailor. 

Since the above estimate was made — that is, from the first 
of September, 1846, to the first of September, 1854, a period 
of eight years, I treated four hundred and ninety-seven 
additional cases of fistula in ano ; making in all, during a 
period of seventeen years, eight hundred and two cases. I 
doubt whether any other surgeon, in this or any other coun- 
try, has ever treated so large a number of persons for this 
one disease, in so short a time, and with such complete suc- 
cess. The celebrated Peter de Marchetti, who was professor 
of surgery and anatomy at Padua, in 1725, remarked before 
his death, that he could affirm without vanity, that he had 
cured above six hundred cases of fistula of the anus. His 
method of treating this disease was the knife, combined with 
either the actual or potential cautery — that is, the red hot 
iron or caustic. I can with equal propriety and without 
boasting affirm, that I have, within seventeen years, radically 
cured upwards of seven hundred cases of fistula in ano, and 
that too without either the knife, the actual or the potential 
cautery. 



CHAPTER III. 

The Anatomy of the Rectum and Anus. 

I cannot introduce the diseases described in the following 
pages, in a more appropriate and useful manner, than by first 
giving a short description of the anatomy of the rectum and 
anus, and their relative position with regard to the several 
organs contained in the pelvis. In doing this, however, I 
shall be compelled to use technicalities ; for I find it utterly 
impossible to avoid them. 

That portion of the alimentary canal which has obtained the 
appellation, rectum* occupies the posterior part of the pelvis, 
and is continuous with the large intestine called the colon. 
(Yide Plate I.) It commences at the termination of the sig- 
moid flexure (double curve) of the colon, opposite to the left 
sacro-vertebral articulation, and it terminates at the anus. It is 
about twelve inches long, varying slightly, however, in dif- 
ferent subjects, according to their stature. Its form is cylin- 
drical at its commencement, and, indeed throughout a con- 
siderable portion of its extent ; but towards its lower extrem- 
ity, however, it becomes large and saccated, forming a ter- 
minal pouch, which is dilated and flattened from before back- 
ward, and the mouth of which is closed by the internal 
sphincter ani muscle, like a purse. This dilatation or pouch, 

* The terra rectum, which signifies straight, when applied to the terminal portion 
of the intestinal tube in the human subject, is neither correct nor at all appropri- 
ate ; for it will presently be demonstrated that it is not straight, but curved, both in 
the antero-posterior and lateral direction. 



PLATE I. 



Stomach and Intestines 







w 





w 
■ ; " 

H K 

EXPLANATION. H 


a The 


OK s aplia|iis . 


B.Hie 


Stomach 


c.The 


Small Jntestmes . 


o.Ihe 


Colon or Great Bowel 


t.Ike 


As c ending C olon 



F.Hie Iransrerse Colon. 
G.Tlie Descending Colon, 
i. The Itecfcinn. 
K.The Tcmchofthe Rectum 
L.Ihe Sphmcter ArlMilscI 
M.Ihe Anus . 



ANATOMY OF THE RECTUM AND ANUS. 29 

in consequence of the peculiar organization of the part, is 
capable of acquiring great size, and in some instances, of 
long continued retention of feces, it has been found to occupy 
a very large portion of the cavity of the pelvis. 

The size of the rectum for some distance, is nearly con- 
tinuous with that of the sigmoid flexure of the colon ; but 
differs from the other portions of the intestines by its 
becoming wider in its downward progress, until it reaches 
the upper margin of the internal sphincter ani muscle. From 
its commencement on the left side, at the upper opening of 
the pelvis, it is directed from above downward, and at first a 
little obliquely from left to right, descending into the pelvis 
along the anterior surface of the sacrum for about six inches, 
occasionally undergoing, in some subjects, slight lateral inflec- 
tions, until it has arrived at the median line of the body, at 
a point opposite the junction of the third and fourth bone of 
the sacrum, adapting itself during its downward course to the 
curvature of the bone over which it had to pass. From this 
point, it is then directed obliquely from above downward, 
and from behind forward, for about four inches, still in the 
middle line, to the extremity of the coccyx, (lower end of the 
spine,) and on a level with the prostate gland. Finally, from 
immediately below the level of the prostate gland ; it is then 
directed obliquely from above downward, and a little from 
before, backward for about one inch and a half, to terminate 
at the anus. 

For the purpose of better elucidation, the rectum may be 
distinguished into three divisions — a superior, (upper,) a cen- 
tral and an inferior, (lower) ; the three main curvatures 
which the organ describes in its downward course, being 
made the foundation of these natural divisions ; each of which 
is distinct in its situation and connections, with regard to the 
several organs in the pelvic cavity. The superior (upper) 
portion extends from the commencement of the rectum, at 



30 ANATOMY OF THE EECTUM AND ANUS. 

the lower end of the sigmoid flexure of the colon to the junc- 
tion of the third and fourth bone of the sacrum, just where 
the rectum leaves its peritonseal investment to curve below 
the bladder. It is about six inches long, being the largest 
portion, and about half the length of the whole organ itself. 
In its direction downward, as has already been noticed, it 
describes a curve, the convexity of which is turned backward, 
and corresponds to the sacrum. Anteriorly it corresponds to 
the posterior surface of the bladder in the male, and to the 
womb and a small portion of the vagina in the female, and 
in both sexes to a fold of the ileum lodged in the intervening 
cul-de-sac. It is tortuous, smooth and loosely attached to the 
left half of the anterior surface of the sacrum by a short fold 
of the peritonaeum, called the meso-rectum. This portion of 
the rectum might with great propriety be termed the perito- 
nseal portion, because of its being completely invested by this 
membrane. 

The central portion commences where the organ leaves its 
peritonseal envelop and begins to go below the bladder. It is 
about four inches long, and its direction is obliquely from 
above downward, and from behind forward, slightly curving 
in the same direction, the convexity bearing upward. It is 
fixed and immovable, and always corresponds anteriorly to 
the vagina in the female, and in the male to a small portion 
of the posterior part of the bladder, from which it is sepa- 
rated downward and outward by the seminal vesicles, and 
vassa deferentia, and lies in close relation with them. Towards 
its termination, it corresponds to the prostate gland and the 
commencement of the membranous portion if the urethra, 
and is in contact with them. In the female it is very inti- 
mately and firmly connected to the vagina by a vascular net 
work, constituting the recto- vaginal septum ; but in the male 
it is but loosely connected to the base of the bladder and 
prostate gland, by a layer of cellular tissue of a soft and lax 



ANATOMY OF THE RECTUM AND ANUS. 31 

character. It differs quite materially in its organization, 
structure and attachments from the upper, or free portion, 
being attached to the parietes of the pelvis in a very strong 
manner, and being destitute of the peritoneeal covering, 
except a small portion on the upper part of its anterior face, 
over which the peritoneum is sometimes extended, when the 
bladder is empty. 

The inferior (lower) portion of the rectum commences at 
the extremity of the coccyx, and terminates at the anal ori- 
fice. Its length is about one inch and a half, and its direc- 
tion is obliquely downward and backward. This last inflec- 
tion separates it from the urethra in the male, and from the 
vagina in the female. It is of greater capacity above than 
below, and is surrounded by dense adipose cellular tissue, 
except at its upper extremity, in front, where it is closely 
attached to the prostate gland. In its lower three- fourths, it 
is completely invested by the sphincter ani muscles. This 
portion of the rectum might, with great propriety be termed 
the anal portion, or anal canal. 

The structure of the rectum, like that of the other hollow 
viscera of the abdomen, consists of three tunics, aperitoneeal, 
a muscular and a mucous, which are united to each other by 
cellular tissue. Sufficient has already been said with regard 
to the peritonseal tunic for our present purpose. The muscu- 
lar coat of the rectum is of greater density and strength than 
that of any other portion of the intestinal canal, and is com- 
posed of two layers of fibres, an external longitudinal, and an 
internal circular layer. The first of these is formed from the 
longitudinal fibres of the colon, which are arranged in three 
bands, uniting at the rectum into two layers ; these, how- 
ever, speedily expand into one coat, the strength of which 
diminishes the nearer we approach to the internal sphincter. 
The internal circular fibres are quite distinct, and exist in all 
parts of the rectum. Yet in the superior and middle por- 



32 ANATOMY OF THE RECTUM AND ANUS. 

tions, they are less numerous, pale, thin and disgregated, 
and do not form a complete, covering. As they approach the 
lower extremity of the middle portion, however, they lose 
their pale and delicate appearance, become stronger, more nu- 
merous and more closely set together, until they reach the 
superior extremity of the lower portion, where they become 
blended, and constitute the internal sphincter muscle. It is 
in consequence of these fibres being weak, thinly scattered, 
and having considerable interstices between them, that the 
superior and middle portions of the rectum are so capable 
of great distention. Hence in obstinate constipation, instan- 
ces occur in which these portions of the rectum are most 
enormously distended with faeces, the spaces between the 
fibres forming so many cells for the collection of such accu- 
mulations. The mucous coat of the rectum is much more 
ample, much more vascular and considerably thicker, redder, 
and more porous than any other portion of the large intes- 
tines. When the rectum is empty, its mucous coat is thrown 
into undulating folds, varying in number and size ; near to 
the anus, these are larger than in the upper portion, and 
were denominated by Morgagni, the columns of the rectum. 

The mucous glands as well as the absorbent vessels of the 
rectum, are numerous; the former secrete a fluid which 
lubricates the internal surface of it, and facilitates the 
passage of the fseces. These glands occasionally become 
enlarged from long continued irritation, appearing like so 
many tubercles, in the centre of which will generally be 
found a small black speck, which shows the orifice of the 
excretory duct. 

The arteries of the rectum originate in three sources, and 
are divided into the superior, middle and . inferior hemor- 
rhoidal. The superior result from the division of the inferior 
mesenteric. They descend along the posterior surface of the 
rectum, dividing into numerous branches which ramify upon 



ANATOMY OF THE RECTUM AND ANUS. 33 

the lateral and anterior surface, anastomosing with the 
branches of the opposite side, and with the middle hsemor- 
rhoidal. The middle hemorrhoidal generally arises from the 
internal iliac. Occasionally, however, it is a branch either 
of the ischiatic or internal pudendal ; descending obliquely 
on the anterior surface of the rectum, it divides into various 
branches, which anastomose above with the superior, and 
below with the inferior hemorrhoidal. The inferior he- 
morrhoidal arteries arise from the internal pudendal ; they 
ramify in the fat and cellular substance, surrounding the 
anus, and supplying the sphincter ani muscles, they anasto- 
mose with the middle hemorrhoidal. The arteries of the 
rectum are more numerous and of larger size than they are 
in any other part of the large intestines. Hence operations 
on its lower portion are sometimes attended with serious, if 
not fatal hemorrhage. 

The veins of the rectum are derived from the inferior 
mesenteric, the pudic, the ischiatic and the middle hemor- 
rhoidal, and correspond to the arteries of the same names. 
They are quite tortuous, and towards the commencement 
of the inferior portion of the rectum are peculiarly capa- 
cious, numerous and thin, especially those deficient of valvu- 
lar structure. The branches of these veins, taken collectively, 
constitute a plexus, termed the hemorrhoidal, which is sit- 
uated in the inferior portion of the rectum, between the- 
mucous and the muscular coat. Some of the branches of 
this plexus pass through the internal sphincter muscle^ supr 
ply the cellular and adipose tissue, at the side of the rectum,, 
and then anastomose with the body of the plexus, below 
the inferior margin of this muscle. It will be observed 
that the inferior mesenteric is a part of the portal division 
of the circulation, destitute of valves, and that the hemor- 
rhoidal plexus partakes of the same character. It is thus 

that a full connection is established between this plexus 
3 



34: ANATOMY OF THE RECTUM AND ANUS. 

and the portal and general venous systems, which is of great 
importance, both* in a medical, as well as surgical point of 
view. There is sometimes an enlarged and varicose condi- 
tion of the proper veins of the anal region, especially in 
old persons, and in those who labor under diseases of these 
parts, such as anal fistula, haemorrhoids, stone in the bladder, 
&c. In such cases, when these veins are divided, there 
sometimes follows the most alarming, if not fatal hemor- 
rhage. There is also great danger of serious bleeding, when 
the parts are indurated from inflammatory deposits, and 
consequently when the divided vessels are unable to retract. 

The nerves of the rectum are principally supplied from 
the sacral and hypogastric plexus. Those derived from the 
sacral plexus descend to the posterior part of the inferior 
portion of the rectum. In their descent, after distributing 
ramifications to the hypogastric plexus, divide into two sets 
of branches, one of which ascending, goes to the sigmoid 
flexure of the colon, whilst the other, descending, extends to 
the external sphincter muscle. Both of these sets of branches 
terminate partly in the mucous, and partly in the muscular 
coat. Those derived from the hypogastric plexus proceed 
forward and downward, and are distributed to the rectum 
and anus. 

The rectum is the only portion of the intestinal canal 
which receives additional nerves from the cerebro-spinal 
system ; hence it is endowed with much greater sensibility, 
and consequently subjected to a much greater number of 
influences, both healthy and morbid, than any other portions 
of the canal ; hence its functions, too, are of a mixed cha- 
racter, partaking, in part, both of voluntary and involuntary 

motion. 

The Anatomy of the Anus. ' 

The Latin term anus, which implies a circle, is used to 
designate the orifice or outlet at the inferior extremity of the 



ANATOMY OF THE EECTUM AND ANUS.. 35 

rectum, through which the fasces make their final exit from 
the body. 

For the purpose of preventing the inconvenient, the dis- 
gusting, and the constant excretion of the faaces, the anus is 
furnished with two circular muscles, especially intended to 
control i it, denominated sphincters, or constrictors. These 
two muscles, which are alone proper to the anus, are called 
the external and internal sphincters. The external or cuta- 
neous sphincter ani muscle is composed of a broad flat band 
of elliptical fleshy fibres, about an inch " in thickness, and 
the same in breadth, placed immediately beneath, and inti- 
mately united to, the skin of the anus, the orifice of which 
it completely encircles. 

The internal sphincter ani muscle is a flat and slightly oval 
muscular ring, composed of the circular fibres of the rectum, 
so multiplied and so closely aggregated as to form a com- 
plete coat encircling, like a belt, the upper margin of the 
inferior portion of this viscus. It is situated immediately 
below the terminal pouch of the rectum, and varies from 
half an inch, to one inch and a half in breadth, and from an 
eighth, to a quarter of an inch in thickness. 

A knowledge of the natural action of these two muscles, 
as well as their action and sympathies in the morbid state, 
is of the highest consequence ; especially when we take 
into consideration the great importance of the organ to which 
they are subservient, or the diseases with which they are 
often connected, or to which they themselves are liable. 
They sometimes produce a sympathy among the subordinate 
parts, which is often of the most distressing character ; as in 
fissure of the anus, hcemorr hotels, constipation, &c. ; for any 
one of these diseases may, and does sometimes, excite the 
most painful action of one or both of these muscles. Indeed 
there are but few muscles more novel in their organization and 
in their functions, and which are more deserving of attention. 



CHAPTEE IV. 

The Physiology of the Rectum and Anus. 

A knowledge of the anatomy of the rectum and anus 
naturally leads to a consideration of the functions, or physi- 
ology of the same organs. These, in my opinion, are among 
the most beautiful instances, elucidating that science, in the 
whole human body. 

To the rectum, and especially its pouch, belongs the office 
of reception and accumulation of the faecal matter ; whilst 
to the sphincter ani muscles, belongs the office of retaining 
it, and finally aiding in discharging it. The rectum, there- 
fore, may with great propriety be styled the terminal depot 
of the alimentary canal. The most superficial observer can- 
not but be struck with the utility of the peculiar form of this 
organ, for had it been straight, as its name implies, we should 
have been continually annoyed, especially when on our feet, 
by a disposition to empty it ; not only, however, are we by 
its peculiar formation protected against this, but the pouch 
of the rectum allowing a large quantity of matter to collect, 
gives sufficient time for the absorbents of the part to take 
up any nutritive portions of food that might, if possible, still 
remain. The first portions of the alimentary mass, after be- 
ing almost wholly deprived of their nutritive properties, are 
carried forward by the peristaltic (vermicular or wormlike) 
action from the ileum to the csecum, — thence transmitted 
along the colon, they finally enter the rectum. As each 
successive portion is received into the superior part of the 



PHYSIOLOGY OF THE RECTUM AND ANUS. 37 

rectum, the former one is propelled forward by the impulse 
given it from behind, assisted by the contractile power of the 
part itself, till they eventually arrive at the inferior or lower 
part of the rectum, where they slowly accumulate, and grad- 
ually distend it, until, sooner or later, an uneasy sensation is 
experienced on its parietes, which has been denominated " a 
call of nature" and which is followed by the act of exon- 
eration. 

Although the rectum, from its peculiar muscular structure, 
is completely equipped as an expulsive organ, it would never- 
theless fail to fulfil its offices as such, were it not suitably 
endowed with nerves, like telegraphic wires, to put it in rela- 
tion, or in communication with other organs, and enable it to 
receive and to respond to impressions made upon it. In the 
preceding chapter, I have shown that this organ, in addition 
to the organic sensibility with which it is endowed, in com- 
mon with all parts of the intestinal canal, by nerves from 
the ganglionic system, is also endowed with animal sensi- 
bility, by nerves from the cerebro-spinal system, the peculiar 
property of which is, that kind of sensibility which we can 
plainly perceive, and of which we are distinctly conscious. 
By this last peculiar nervous endowment, the rectum is ena- 
bled to give admonition of the presence of the collected 
fsecal mass in its own cavity, a power which no other 
portion of the intestinal tube possesses ; for, although the 
organic sensibility of the whole canal enables any part of 
it to perceive the presence of the alimentary mass which 
stimulates it and produces the peristaltic action ; yet we are 
not conscious of this sensibility, nor of this action ; neither 
are we conscious of the passage of this mass through the 
intestines, nor of its presence at any particular part ; but no 
sooner has a certain quantity collected in the rectum, than a 
sensation at once is experienced which informs us of its pre- 
sence there, and which calls for its expulsion. " After the 



38 PHYSIOLOGY OF THE RECTUM AND ANUS. 

deglutition of our food," says Dr. Black, " we have no fur- 
ther control over its mode of action and passage through 
the stomach and bowels, than if it had been committed to 
the interior of another animal ; and it is only when the refuse 
or recrementitious matter arrives at the lower part of the ali- 
mentary canal, that we can again recover any cognizance or 
control over the natural and independent disposal of our 
aliment. As the ganglionic system of nerves takes up the 
office of digestion and assimilation from the voluntary nerves, 
at the threshold of the alimentary conduit, so they in time 
consign the recrementitious matters over to the same sentient 
and motor nerves at the opposite outlet of the body." — {A 
Manual on the Bowels, p. 166. London, 1840). 

" These ganglionic organs," says Dr. Johnson, " not only 
refuse to tell us how they perform their operations in their 
hidden laboratories, but when they are at work. Thus in a 
state of health we have no conscious sensations from the vital 
functions of the circulation, respiration, digestion, assimila- 
tion, secretion, &c. The heart feels the presence of the blood, 
but keeps that feeling to itself. The lungs feel the influence 
of atmospheric air, but gives the mind no intimation of such 
feeling. The stomach is alive to the presence of food, and 
performs the important task of digestion, but troubles not 
the intellect with any intimation of its proceedings ; and so 
of all the other internal organs. This is a wise provision of 
Nature ; or rather of Nature's God." {The Economy of 
Health, p. 134. London, 1843). 

The contraction of the rectum, aided by the diaphragm and 
abdominal muscles, is the efficient cause of the expulsion of 
the faeces. Of these agencies the rectal contraction is the 
principal, the diaphragm and abdominal muscles co-operating 
only in a subordinate manner. The rectum alone performs 
the dilatation of the sphincter ani muscles, preparatory to 
the passage of the faeces, and may also suffice for their com- 



PHYSIOLOGY OF THE RECTUM AND ANUS. 39 

plete expulsion. Of this fact any one may convince himself 
by sitting up straight whilst at stool, and sufficiently high, so 
that his feet would not touch the floor. In this position the 
diaphragm and other abdominal muscles would be made 
quiescent, during defecation. That the chief expulsive force 
resides in the rectum, and especially in its anal portion, will 
be seen in the above instance, as well as in cases of involun- 
tary discharges which pass off without the agency of the 
abdominal muscles. 

What has been said relative to defecation, together with 
the parts both directly and indirectly concerned in this act, 
must be understood as having reference to their healthy or 
normal, and not to their morbid or abnormal action ; for this 
act is not always under the control of, or in obedience to the 
will ; as, for instance, when involuntary discharges take place 
from the rectum, the parts more or less concerned in this 
operation, are laboring under disease. The brain may be so 
affected that the will may be incapable of action ; or the 
sphincter ani muscles may be so morbidly irritable as not to 
be at all under the control of the will ; or the actions asso- 
ciated with the irritations of the rectum may be so susceptible 
of impressions as to compel the sphincter muscles into obedi- 
ence. Many of the most frequent, tormenting and violent 
evacuations from the rectum are not consequent upon the 
presence of faecal matter in this viscus, as is seen in the 
tenesmus of dysentery ; neither is distention of the rectum 
always necessary to the accomplishment of the act of expul- 
sion, as is seen in diarrhoea and dysentery. Consequently all 
such acts must be looked upon as illustrative of an unhealthy 
or abnormal character. 

As a general rule, the excrementitial residuum of one 
day's aliment taken into the stomach and amassed in the rec- 
tum, is sufficient to provoke the expulsory movement. The 
frequency, however, of the fsecal evacuations, is by no means 



40 



PHYSIOLOGY OF THE RECTUM 'AND ANUS. 



certain, depending, in a great measure, upon the nature and 
the quality of the food ; upon the habit of the individual ; 
upon the age, the sex, the constitution and the occupation. 
With regard to the habit, there is perhaps no functional act 
of the whole body more under its influence, than that of de- 
fecation. In children, the faecal dejections take place more 
frequently than in adults, being usually in proportion to the 
number of meals. This frequency is doubtless in conse- 
quence of the digestion of children being much more rapid, 
the intestinal secretions more profuse, the faeces much more 
fluid, and the sensibility of the alimentary canal much 
greater. It may also, in a great degree depend upon the 
fact, that in childhood the rectum is wholly uninfluenced by 
the will. In females, the intervals of defecation are less 
frequent, and the dejections less copious than in males, doubt- 
less in consequence of the absorbents extracting a large pro- 
portion of the nutritious matter from the food, and the men- 
strual evacuation being a kind of substitute for, or supply- 
ing the place of, the intestinal secretions ; hence the bulk of 
the excrementitious mass from these causes, would necessarily 
be greatly reduced. 

Whilst the accumulation is taking place in the rectum, the 
fluid portions of the faecal mass are gradually being absorbed, 
together with any nutritive particles that may have been left 
in it. Should the dejections occur regularly, once in twenty- 
four hours, no unfavorable change in the excrementitious mat- 
ter 'would result, but should they be protracted much beyond 
this period, the mass would gradually become compact, then 
indurated, friable and knotty — so much so that its evacuation 
would be rendered both difficult and painful. Such, however, 
is the influence of habit, that occasionally cases do occur in 
which no alvine dejections take place for days, and even for 
weeks, without the occurrence of any unpleasant circum- 
stances. In such cases the protracted presence of the fecu- 



CONSTIPATION". 41 

lent matter obtunds the organic sensibility of the rectum, so 
that it requires something more than the accumulation to 
stimulate it to the expulsive effort. In those who are most 
regular in their bowels, defecation takes place in the morn- 
ing immediately after rising, or immediately after breakfast, 
when the perceptive power of the nervous system is most 
active, and when the organic sensibility of the alimentary 
canal is revived, after having remained quiescent during the 
hours of repose. 



CHAPTEK V. 

CONSTIPATION. 

The term constipation is derived from the Latin constipo, 
to crowd together ; a compound of con and stipo, to fill up 
close. The corresponding term obstipato, under which cos- 
tiveness is usually described by Latin authors, is from o~b and 
stipo, to stop up. The true import of the word constipation, 
therefore, would appear to be the collecting and impacting 
of the excrementitious matters, the residuum of the various 
processes concerned in alimentation, in some part of the 
intestinal tube. 

Constipation of the lower bowels, is a most fruitful source, 
and a most frequent accompaniment of the diseases treated 
of in this work. I have, therefore, concluded to devote a 
short space to its consideration. To enter fully into the 
causes, the symptoms and the remote sympathetic diseases 
and consequences of constipation, would far exceed the limits 
and the objects of this present work. A few observations, 
however, upon the most common causes of constipation, 
together with the most simple means of obviating that condi- 
tion, will not be considered out of place. 



42 CONSTIPATION". 

Causes of Constipation. 

Perhaps the first and most common cause of costiveness, 
is a proper want of attention to the calls of nature. I have 
already shown in the chapters on the anatomy and the phy- 
siology of the rectum and anus, that nature has designedly 
made provision for the retardation as well as the accumula- 
tion of the faecal matter in the rectum, by supplying this 
organ with a sack or pouch, and its extremity with a muscu- 
lar mechanism, in subjection to the will, for the purpose of 
opening and closing it. This controlling or restraining power, 
when properly and duly exercised, is highly essential to our 
comfort and our convenience ; but when abused, in order to 
postpone, or to set aside the admonitions of nature, so as to 
retain the excrementitious matters beyond the period when 
nature calls for their expulsion, the most serious consequen- 
ces, sooner or later will inevitably ensue. In the brute crea- 
tion, and in early childhood, the calls of nature are never 
disobeyed — never neglected ; — but the natural functions are 
suffered to go on at all times without any interruption or 
restraint whatever. Unfortunately the customs and callings 
of civilized life too often interfere with the strict fulfilment 
of this injunction of our nature ; and it is frequently suffered 
to be interrupted, or set aside by the most trivial circum- 
stance. A false or misplaced sense of delicacy, a most tri- 
fling engagement, or sheer indolence is permitted to interfere 
with the exoneration of the rectum, a natural and necessary 
function, and one without which health can neither be enjoyed 
nor preserved. Little do such persons reflect, at the time, of 
the ill health and the suffering that they are entailing upon 
themselves, by such a course of conduct. Dr. Burne, in his 
invaluable work on " Habitual Constipation," makes the fol- 
lowing just remarks on this subject. "How often does it 
happen that ladies, feeling it not quite convenient to retire 



CONSTIPATION. 43 

to the closet at the moment they experience an admonition, 
defer it till a more favorable opportunity ; but this opportu- 
nity having arrived, their efforts are powerless. The bowel 
will not then act, and disappointment and discomfort ensue. 
Delicacy on their part is carried to a most pernicious extent 
in England, while on the other side of the channel, the reverse 
obtains — happily, perhaps, as regards health and ease. An 
English gentleman, while in France, having one day occa- 
sion to go to the cabinet d'aisance, found it occupied by a 
lady — the door not being bolted. Embarrassed, he retreated 
to his apartment, where in a few minutes, another lady of the 
family came to him saying, i Monsieur ! la place est libre ! ' 
The Englishman blushed for an instant ; but quickly recov- 
ering, said to himself, en allant, Eh bien ! If Madame feels 
no delicacy in this matter, why should I ?" (jp. 110 Phila- 
delphia* 1840.) 

Continued care and anxiety of mind are also causes of 
constipation of the bowels. The great anxiety to which those 
are subjected who are continually and actively engaged in 
their business or profession, exerts a powerful influence upon 
the functions of the alimentary canal ; it not only depresses 
the nervous system, and causes indigestion, but also renders 
torpid the peristaltic action of the bowels. As a confirma- 
tion of the truth of this, as soon as such persons emancipate 
themselves from the cares and anxieties of their business, by 
taking an excursion into the country, the mind soon recovers 
its wonted cheerfulness, the spirits their elasticity, and the 
bowels their normal function. Indeed, when we take into 
consideration the contentions, the competitions, and the 
responsibilities which this class of persons have daily to 
encounter, especially in large cities, it is a matter of no sur- 
prise that they should suffer from languor and depression, from 
indigestion and from constipation with its numerous evil con- 
sequences. 



44 CONSTIPATION. 

Sedentary habits, or the sedentary occupations of life, 
greatly tend to constipation and inactivity of the bowels. 
Hence men of literary pursuits, or those closely occupied in 
study, as students, or employed at the desk or counter, as 
clerks and accountants ; or those confined to seats, as seam- 
stresses, milliners, tailors, &c, are all extremely liable to suf- 
fer greatly from confined bowels. The want of bodily exer- 
cise, generally lessens the demand for food, weakens the 
digestive organs, and indigestion and constipation are almost 
a necessary consequence. 

Some of the causes of constipation among the richer and 
higher classes of people, are the modern and irregular hours 
of society, including late breakfasts, late dinners, and all the 
long nocturnal pastimes of music and dancing in crowded 
and heated rooms, &c. ; all of which necessarily imply many 
contraventions and restraints of the laws and of the regular 
discharge of the functions of nature. 

Travelling very generally produces temporary confinement 
of the bowels, doubtless in consequence partly, of a want of 
the proper conveniences as well as the opportunities for the 
exoneration of them. The regular attention to the periodical 
calls of nature is with so much more difficulty given when 
the individual is travelling, than when he is stationary, or at 
home. It may also be, in part, owing to the insensible per- 
spiration being increased by travelling, and the absorbing 
actions throughout the cavities being also augmented, Ladies 
frequently are rendered quite ill from this cause, constipation 
always increasing the feverish heat which arises from trav- 
elling in a close carriage. These unpleasant annoyances and 
sufferings to which travellers are so subject, often mar all the 
anticipated pleasures and enjoyments of their journey. They 
should, therefore, never set out to travel either by land or by 
sea, without first providing themselves with every proper and 
necessary means for obviating constipation. 



CONSTIPATION. 45 

A want of the proper accommodations for the exoneration 
of the bowels is a frequent source of constipation. "Water 
closets, as a general rule, are entirely too deficient in number. 
Sometimes one only for a large family, and even this, often 
most unfortunately situated — most awkwardly constructed, 
and most filthily kept. There should never be less than at 
least four closets in every house — one appropriated to each 
sex — one attached to the visiter's apartment exclusively, and 
one for the servants. The out-door privies or cabinets 
(Paisance are also often badly planned, or inconveniently 
situated — -being too far from the house, or being in a locality 
which is cold, damp, or otherwise repulsive ; or the access to 
them being too public, &c. It certainly would be attended 
with very little additional expense and trouble to construct 
in-door closets, as well as out-door cabinets in a proper and 
suitable manner, in sufficient numbers, and in places con- 
venient and approachable, in which the access would be 
easy, and the egress private, and also to keep them ventil- 
ated, fumigated and clean. How strange that such vast sums 
are expended and such pains taken in the construction, the 
arrangement and the decoration of palatial edifices, whilst an 
utter disregard is so often manifested respecting the one 
thing needful — the conveniences which are so necessary to the 
health, the comfort and the enjoyment of a family and its 
visiters. An architect might immortalize his name, were he 
to give his special attention for a short time to improvements 
in the construction of water closets. It is true that the incon- 
veniences alluded to, do not exist to the same extent in this 
city, and consequently are less felt here than in other cities 
of the United States and throughout the country generally. 
Yet even here in ]STew York, with all the advantages of the 
Croton water, there is still great room for improvement in 
this respect. Who has not often sadly experienced in his 
own person inconveniences, troubles, difficulties and annoy- 



46 



CONSTIPATION. 



ances like those enumerated ? Some may think these sour- 
ces of costiveness as of but little import, and consequently 
pass them by. They are notwithstanding, of grave impor- 
tance ; for they all conspire more or less to counteract the 
operations of nature, and to originate constipation. 



Peculiarities Respecting the Action of the Bowels in some 



It is of great importance that defaecation, or the evacuation 
of the bowels should be healthily and normally performed. 
Yet ingesta and the alvine discharge cannot, however, be 
regulated upon any general and uniform principle, such as 
the supply and waste of a steam engine. There are so many 
relative forces and inertia at work in different individuals, 
that each almost becomes of himself an independent piece of 
vital mechanism. Owing to the different habits and consti- 
tutions of different persons, that which would constitute a 
natural periodicity of the bowels in one, would perhaps be a 
debilitating laxity in another. Constipation or slowness of 
the bowels, should therefore be strictly determined by the 
laws which habitually govern the individual himself. With 
the largest majority of persons, the bowels are usually 
relieved every twenty-four hours, either immediately on rising 
in the morning, or after breakfast ; the impulse given to this 
function, being doubtless either the increased pressure on the 
lower bowels, by assuming the erect posture, or the disten- 
tion of the stomach by the first meal. Although as a gen- 
eral rule, the bowels should be freely moved once every day, 
3^et there are exceptions to this, in which persons in health, 
have two, three and four soft motions daily ; whilst others 
again require but one evacuation in three, four or five days. 
These peculiarities of constitution should always be taken into 
consideration ; they should always be carefully distinguished 



CONSTIPATION. 47 

from the results of the bad management of, or the inattention 
to, the right performance of the excretory function. I could 
here relate several very remarkable instances which came 
under my own observation, of the peculiarities in some indi- 
viduals with regard to the action of their bowels. I could 
also give a large number of such cases from authors, but have 
only room in the present work, for the following. Two extra- 
ordinary instances of peculiarity in this respect are related by 
Heberden. In one instance, the bowels were moved but once 
a month. In the other they were moved twelve times daily, 
for thirty years. {Commentarii de Morborum, Historia et 
Curatione. Editio Altera, p. 14, Londini.) Renauldin 
mentions the instance of a lady who passed ordinarily a 
whole week, and sometimes ten and fifteen days without 
going to the closet, and she was scarcely ever indisposed. — 
(Dictionaire des Sciences Jfedicales, tome vi.p. 254.) The 
diurnal evacuation of the bowels should, however, always be 
promoted and established, and should, if possible, take place 
in the morning. This is the more general and natural custom 
from youth up to advanced life, and is most conducive to 
health and to comfort, and is also consonant to that periodi- 
cal order which nature affects in our daily supply of food, 
followed every twenty-four hours by a long suspension of 
ingesta and of exercise during the night. 

Prophylactic Treatment of Constipation. 

As constipation is a source of so much evil, the primary 
cause of so many diseases, especially the most of those 
named in this work, its prevention or removal, therefore, 
is of the utmost consequence ; and this, I am happy to 
say, is generally in the power of almost every individual 
himself, to accomplish, and that frequently, without pur- 
gative or any other medicine. The principal objects to be 
attained in the treatment of constipation, is to ascertain 



48 CONSTIPATION. 

the cause and remove it ; to procure fsecal evacuations by 
the most simple, mild, and least irritating means; to restore 
the lost tone of the bowels ; and to prevent the recurrence 
of this torpid condition. These important objects may, in 
the majority of instances, be accomplished by invariably 
visiting the water-closet once daily, and soliciting an evac- 
uation, whether there is a natural inclination or not, by 
the use of enemata ; by regular exercise ; and by diet. 

Visiting the Water- Closet Once Daily. 

All the bodily functions are capable of being influenced 
by, and subjected to habit. Nothing conduces more to the 
healthy action of the bowels than attention to this principle. 
Next to early rising, and not less important, is the habit of 
visiting the water-closet regularly at a certain period every 
dav, and strictly obeying the calls of nature, soon after 
breakfast being the best time. Bv observing regularly the 
same period in the twenty-four hours, for the relief of the 
bowels, whatever has been formed or accumulated in them 
is found to be prepared at the recurrence of those periods 
for elimination, and to have been brought to the rectum for 
that purpose. Many persons scarcely take time to eat or to 
evacuate their bowels ; when they do eat, one would sup- 
pose that mastication was entirely superfluous ; so when 
they retire to the water-closet, such is their haste, that if 
nature does not relieve herself at the moment, they make 
no further effort ; and constipation is thus allowed to take 
place and to continue, and which after a while cannot be 
overcome by any efforts, short of the assistance of artificial 
means. The calls of nature should never be neglected, 
however slight they may be, but at once attended to ; and 
what is still more important, if the effect should not imme- 
diately take place by the first effort as anticipated, the 
individual should wait patiently and " solicit nature" until 



CONSTIPATION. 49 

it does take place. By persevering in this manner, that end 
will be accomplished, which would otherwise seem impos- 
sible. We are creatures of habit, and I have known many- 
persons who, by their continued applications to the temple 
of 'Cloacina for relief in this respect, have finally obtained 
it permanently. I have already commented upon the evils 
resulting from a want of attention to the admonitions of 
nature. 

Enemata.* 

Kectal injections were, a few years ago, in this country, 
viewed with the greatest disgust, and even with horror, and 
were scarcely ever resorted to, except on extraordinary occa- 
sions, when advised by a physician. Now, however, they 
are becoming quite common. They may be abused, it is 
true, but their abuse is by no means attended with the evil 
consequences, as is that of purgative medicine. The French 
and Germans are constantly employing them all their lives ; 
sometimes for the purpose of disburdening themselves after 
excess in eating ; and from the fact that they generally use 
them warm and medicated, they doubtless do more or less 
ha'm ; yet, even with these attending evils, they by the use 
of this means, save themselves " oceans of draughts and 
bushels of pills /" hence even on the score of economy, they 
are decidedly preferable to purgative medicine. I however, 
never recommend injections but for the purpose solely of 
aiding the efforts of nature ; as soon as the bowels regain 
their natural tone, and are disposed to act of themselves, the 
enemata should for the present be discontinued. 

* Pliny records, that the use of clysters or enemata was first taught by the 
stork, who may be observed to inject water into its bowels by means of its 
long beak. 

" Simile quiddam et volucris in Egypto monstravit, qua? vocatur ibis ; rostri 
aduncitate per earn partem se perluens, qua reddi ciborum onera maxime salubre 
est." 

4 



50 CONSTIPATION. 

As it regards enemata, cold water or cold flaxseed tea 
makes the best lavement or injection that can be used for the 
purpose of overcoming the torpor or inactivity of the lower 
bowels, which exists in constipation. All warm, relaxing, 
and highly stimulating injections should be avoided, as they 
are sometimes the cause of constipation, and where it already 
exists, they only increase it. Medicated injections should 
never be used unless advised by a physician. There is 
nothing more safe, easy and appropriate to call into activity 
the lower bowels in constipation than an enema of cold 
water, or cold flaxseed tea. The effect of it is not so much 
an interference with, or a superseding of nature, as it is a 
simple aid to, or a solicitation of, her ordinary operations. 
As a general rule, such injections are very harmless, and 
remarkably well borne ; they, however, produce in some 
persons, at first, an uncomfortable sensation of cold in the 
bowels and loins, which sometimes continues from a half to 
an hour. Sometimes they produce pain in the bowels and a 
slight diarrhoea ; when this is the case, which is indeed but 
seldom, all that is required is to discontinue them for a short 
time, and to use them only every third or fourth day, instead 
of daily. In the case of individuals in whom there is little 
reaction against cold, it is best not to use the water at the 
ordinary temperature at first, but to begin with it at the de- 
gree of 75° Fahrenheit, gradually coming down to 65°, 59°, 
and 53°, till at length, water of the natural temperature may 
be used. As a general rule, however, cold water to be used 
as an enema should be of a temperature varying, from 55 to 
65 degrees of Fahr., which would be about the temperature 
of cold water in the dressing room in summer ; in winter 
the same water might be as low as 40°. The water of the 
summer temperature would, therefore, be the most proper, 
as it would be more likely to agree best with the majority of 
persons. 



CONSTIPATION. 51 

A variety of instruments have been constructed for the 
purpose of administering enemata, some of which are abso- 
lutely pernicious, whilst others are more remarkable for their 
elegant exterior and extravagant price, than for their sim- 
plicity and usefulness. The best instrument I have seen for 
this purpose is the new Clyso-pwnp, without a piston, of 
Mons. Naudinot, of France. The superiority of this instru- 
ment consists in its forcing the fluid in a continuous stream, 
as well as its simplicity and cheapness. The great objection 
to pump syringes generally, is that they throw the fluid in 
small jets of one or two table-spoonfuls only at a stroke, 
which from the very slow manner of distending the bowel is 
apt to produce ineffectual reaction. I have known persons 
to be disappointed sometimes in their use ; not because a 
sufficient quantity of fluid had not finally been thrown up, 
but because of the slow intermissions, the fluid seldom 
afforded a sufficiently reactive stimulus to the bowels. By 
the instrument, however, which I have named, the distention 
of the bowel being made more rapidly and continuously, is 
consequently much more stimulant, and produces much 
more effective reaction. The common pint pewter syringe, 
I have found to be a tolerably good instrument, especially 
when supplied with an elastic jet. It distends the bowel so 
rapidly and continuously that a nisus for evacuation almost 
immediately occurs. It is not so convenient, however, for 
the individual to use himself. 

The French frequently administer enemata in a very sim- 
ple manner, being upon the principle of hydraulic pressure. 
It consists in putting the fluid to be injected into an elastic 
or water-proof funnel or hose, three or four feet long, about 
four inches in diameter at its upper extremity, and about 
half an inch only at the lower, and capable of containing 
from three to four pints. To the small extremity of the hose, 
a common injection tube of metal or horn is attached, which 



52 CONSTIPATION. 

being introduced into the bowel, the individual himself, or 
an assistant holds the hose in a perpendicular direction, by 
which the fluid is propelled into the bowel by it own gravi- 
tation. If desired, a considerable impetus may be added to 
the already existing force of the fluid, by holding up the 
hose with the left hand, and then gently grasping it with the 
right, about one third of its distance up, and drawing the 
hand down towards the small extremity, and thus force and 
propel the fluid onwards. This is one of the most simple, 
cheap, and safe instruments I have yet seen. The first one 
of the kind I ever saw was at the drug store of Mr. Bonna- 
ble, in JSTew Orleans, a number of years ago. Dr. Edward 
Jukes, of London, the inventor of the stomach pump, has 
made considerable improvement in this instrument, by sup- 
plying it with a loop to hang it up, and a stop-cock, to which 
is screwed a metallic tube, the other end of which is adapted 
for introduction. (Yide Plate YII. Fig. 2). He directs it 
to be used in the following manner : — Having observed that 
the stop-cock at the bottom is turned, so as to prevent the 
escape of the fluid, you pour in at the upper end of the 
hose the fluid intended for injection ; and when it is filled 
within Hve or six inches of the top, you are to hang it up by 
the loop, to a hook in the wall of your dressing-room or 
water-closet, so high that the lower end of the metallic tube 
will just reach to within one inch of the floor ; then place a 
chair at such a convenient distance as will enable you to lay 
the tube on its bottom, when you may sit down, and having 
introduced it, you then turn the cock. He calls this appara- 
tus the flexible Clysma-duct. 

The gum elastic bottle is a good instrument for injecting 
the bowels, as it permits of any quantity of fluid, however 
trifling, being injected with facility. It is especially adapted 
for travellers. 

In New York, in every house in which the Croton water 



CONSTIPATION. 53 

is conveyed, a very simple and efficient method can be 
adopted for injecting the bowel. It is only necessary to have 
an elastic hose of suitable length, with an elastic injection 
tube affixed to one end, to be inserted into the rectum, while 
the other end should be so arranged as to be easily attached 
to the Croton pipe. An enema could thus be taken whilst 
sitting on the water-closet. The injection tube should not 
be withdrawn until sufficient water has been received into 
the bowel to cause a strong nisus to evacuate, without regard 
to quantity. 

All instruments used for the purpose of administering 
enemata should have elastic gum jets, instead of those made 
of metal, ivory, bone, wood, &c. ; more especially, if the 
instruments are to be used by the individuals themselves, as 
they would not be so likely to inflict injury with them, as 
with the hard and unyielding ones in common use. Previous 
to introducing the injection pipe into the rectum, the air 
should always be completely expelled from it, which can be 
done by filling it with the fluid, by a few strokes of the 
piston. By not observing this precaution, the bowel will be 
distended with flatus, which may cause much pain and 
annoyance. 

In this country, there are yet but few people who know 
anything in relation to enemata, and still fewer who under- 
stand the best method of employing them. The operation 
should take place either in the water closet, or in the dress- 
ing room, and as a general rule, need not occupy over fifteen 
minutes, to go through the whole performance. The use of 
any one of the instruments I have recommended, renders the 
administration of this most excellent means so very simple 
and easy that no difficulty whatever need be experienced by 
any one in their frequent use. The method which I have 
found best in the employment of enemata, is to direct the 
individual to throw up into the rectum, from a pint to a pint 



54 CONSTIPATION. 

and a half of cold water, every morning after breakfast, and 
a few minutes before a stool is sought for. The enema, if 
possible, should be retained about five minutes, which allows 
sufficient time for softening the faecal mass and summoning 
into associated action the bowels and abdominal muscles. 
Some persons are in the habit of retaining the injection too 
long — and the consequence is, that not unfrequently, it is not 
passed at all. In very great torpor of the lower bowel, I 
always advise my patients to ply the pump till a strong nisus 
for an evacuation takes place, without regard to the quantity 
of fluid injected ; then a quick, copious and complete clear- 
ance of the colon and the rectum generally takes place. In 
such cases the bowel should always be distended till the con- 
traction commences ; to throw up a small quantity and wait 
fifteen or thirty minutes for the nisus to occur is quite unne- 
cessary, and by no means so effectual. 

In some diseases of the rectum, the injection night and 
morning of about four or five ounces of cold water, or cold 
flax-seed tea, and retained, will often be found highly 
beneficial. 

Exercise. 

Exercise, and especially walking, as it promotes the due 
operations of all the functions of the body, so especially does 
it those of the bowels, the peristaltic action of which it highly 
favors. If taken early in the morning, it will often produce 
an evacuation which would not, perhaps, otherwise have 
taken place. But, alas ! how few are either able or willing 
to devote even thirty minutes, in the early part of the day, 
to any thing but business or study. 

Diet. 

Much depends upon diet in obviating or preventing consti- 
pation of the bowels ; indeed, it is the great counter-acter of 
constipation : but it is impossible to lay down any general 



CONSTIPATION. 55 

rules in this respect, or to furnish any one certain or exclusive 
plan of regimen, in consequence of the various and con- 
flicting idiosyncrasies. Would individuals themselves, how- 
ever, but pay strict attention to such articles of diet as they 
really found to agree with and benefit them in this respect ; 
and to such as disagreed with or injured them, they would 
soon doubtless be enabled, by the information thus obtained, 
to overcome, as well as prevent constipation, so far at least 
as diet is concerned. 

A laxative diet is an important coadjuvant in constipation, 
and one among the most necessary articles of this character 
is coarse brown bread. This, if not now, was once the house- 
hold bread of the English ; the panis impurus vel furfura- 
ceus, which, according to Pliny, the Romans used exclusively 
for more than three hundred years ; it is the common bread of 
the hardy Westphalian peasantry ; it is commended as a lax- 
ative by Hippocrates, the Father of Medicine ; the ancient 
luctatores, (wrestlers,) used no other ; and if I am not greatly 
mistaken, there is scarcely a condition of the human body to 
which it is not more congenial than the white bread. In our 
own country, it is only used by dyspeptics, and even they do 
not use it exclusively as their " daily bread" but generally 
use the white bread with it. 

From late highly interesting scientific investigations, it has 
been demonstrated, beyond doubt, that bran possesses highly 
nutritive properties. It has been ascertained that although 
bran contains from five to six per cent, more ligneous sub- 
stance than fine flour, it presents more nitrogenous matter, 
twice as much fatty matter, and besides two distinct aromatic 
principles, one of which possesses the fragrance of honey ; 
and these are both wanting in flour. Thus by sifting, the 
flour is impoverished in nitrogenous matter, fat, feccula, aro- 
matic and sapid principles, in order merely to free it from a 
small portion of ligneous substance. It has, therefore, been 



56 



CONSTIPATION. 



recommended that the bran and the shorts should be ground 
over again, and mixed with the pure fine flour, as this mix- 
ture has been found, bj repeated experiments, to yield a 
much superior bread, and free from the inconveniences of 
that which in some countries is made of coarse meal. 

I have frequently recommended, as a substitute for brown 
bread, a large table-spoonful of pure bran three times daily, 
in as much cold water as would make it thin enough to drink. 

Ripe fruit is generally of a laxative nature, but all fruit is 
not equally good for the purpose of obviating or preventing 
constipation. The best fruit are grapes, strawberries, rasp- 
berries, gooseberries, currants, figs and oranges ; and these 
should be eaten at breakfast. The next best fruit for this 
purpose are peaches, nectarines, pears, apples ; and these 
might be eaten as luncheon. Eipe fruit is certainly not so 
healthy if eaten after dinner, unless it is baked, or otherwise 
cooked, then it might properly form a part of that meal. 
Dried figs, as well as prunes, and dates are valuable auxilia- 
ries in moving the bowels. 

The seeds of the white mustard were at one time a quite 
popular remedy for constipation when caused by a torpid 
state of the muscular coat of the intestines. A tea-spoonful 
of the unbruised seeds, morning, noon and evening, is a dose. 
The seeds of figs, currants and mustard doubtless act like 
bran, by their mechanical irritation of the mucous membrane 
of the bowels, and in this manner promote the peristaltic 
action of the same. Some persons cannot use either of these 
articles in consequence of their producing too much irritation 
in the lower part of the rectum. 

Bacon broiled on the coals and eaten hot for breakfast, or 
boiled bacon eaten cold, is much extolled by some for reliev- 
ing costiveness. A singular remedy, truly ! What is most 
remarkable, however, it is said that the fat of bacon is well 
and easily digested by dyspeptics generally. 



CONSTIPATION. 57 

A glass or two of clear cold fresh spring water taken im- 
mediately after rising in the morning, and friction of the 
abdomen with the hands, the flesh brush, or the coarse towel, 
will materially assist in promoting the peristaltic action of 
the bowels. 

Early Rising, 

Early rising is favorable to the natural action of the bow- 
els. Seven or eight hours for rest, or about one-third of our 
existence in bed, is a normal quantity of sleep ; but few, how- 
ever, can pass all that time in a state of temporary anni- 
hilation. 

I will now conclude this chapter by giving an anecdote 
related by Sir Astley Cooper. " An old Scotch physician," 
says Sir Astley, " for whom I had a great respect, and whom 
I frequently met in consultation, used to say to me, as we 
were about to enter our patient's room together, c Weel, 
Misther Cooper, we ha' only twa things to keep in meend, 
and they'll searve us for here and herea'ter ; one is auways 
to ha' the fear o' the Laird before our e'es, that'll do for 
herea'ter ; and th' t'other is to keep our boo'els auways open, 
and that'll do for here.' " 



CHAPTEE VI. 

Hemorrhoids — Piles.* 

This disease is of great antiquity. It is minutely described 
in all the early works of the Greek and Roman physicians. 
Some Biblical commentators affirm, that the " emerods," 
with which the Philistines were so sorely afflicted, as 
recorded in the fifth and sixth chapters of first Samuel, were 
haemorrhoids of a most severe and aggravated kind.f Be 

* The term Hemorrhoids, which is from the Greek, and literally signifies a 
flowing of blood, and in this general sense was it originally used, is derived from 
one of the symptoms merely of this disease — that of bleeding whilst evacuating 
the bowels. The term, therefore, is not well adapted to convey a very clear and 
correct idea of the nature of this disease, inasmuch as it is frequently unattended 
by any discharge of blood whatever. Custom has, however, sanctioned its use 
in a particular sense, namely, as synonymous with Piles, which is the common 
vernacular designation of tumors about the anus. No very great inconvenience, 
however, can arise from its adoption, as its meaning is now entirely limited, by 
common consent, to the peculiar affection of the rectum, which will be described 
in this chapter. 

t "Webster defines Haemorrhoids to be " A discharge from the anus ; the piles ; 
in scripture, ' emerods.'' " 

Sanctius, on the 6th verse of the 5th chap. 1st Samuel, says, " In summa mor- 
bus est, qui illam praesertim corporis partem infestat, per quam confecti cibi reli- 
quiae et sordes aeguntur quas graeci hozmorrhoides ; Latini, ficus aut mariscas 
appellant." He however says that what befel the Philistines, was something even 
worse than mere haemorrhoids. 

The Hebrew word is " Apholim," which by modern interpreters is translated 
in Latin, ficus or mariscai, that is piles, or haemorrhoids. 

Sanctius also says, on the ninth verse of the same chapter, that the Septuagint 
Chaldaic and ancient Spanish version explain " apholim " by " haemorrhoids." 

Cornelius A Lapide represents that this disease was " Fistula in Ano." Jose- 
phus says, " it was a peculiar kind of dysentery." 



PLATE IT . 














a . Internal files Protruded 



PLATE JIT 




Fiy.1. 




a. Jiibernal Piles 
Protruded 




A . External Piles 
B. Pis sure of hhe Amis 



Fzj. 



HAEMORRHOIDS— PILES. 59 

this as it may, it is doubtless a very ancient disease, and one 
that has caused much annoyance, and still continues to inter- 
fere greatly with the comfort, the convenience, and the hap- 
piness of thousands. The number of persons laboring under 
this vexatious disease, in our own country, is immense. The 
ratio in the west and south, is about one in every ten. 

Description of Piles. 

From the causes which will be named hereafter, the vessels 
of the anus and rectum become preternaturally distended 
with either blood or serum, which, in course of time gives 
rise to haemorrhage, to the formation of tumors, or spontane- 
ously subsides, being generally attended with an inflamma- 
tion and a mucous discharge. This congestion of the vessels 
is evidently the primary and substantive disease. The 
tumors, which are one of its consequences, have been divided 
into internal and external / the former being situated within, 
and the latter without the anus. ( Vide Plates II, III.) Some 
have also distinguished them into bleeding piles , such as dis- 
charge blood, and into blind piles, such as do not discharge 
blood. An appropriate distinction, and one which is seldom or 

Aquila, in the seventh century, translated it " Cancer." 

This disease is mentioned by Herodotus, who calls it Theleia, that is papilla, 
which means pretty much the same as marisca. Theleia comes from Thele, the 
apex of the " Pap," and by similitude, tumors arising on the body from vicious 
humors, (as was supposed) were called papilla. Hence Serenus, speaking of 
that disease, in which the seat, or anus is swollen, says, •' Excruciant turpes anum 
si forte papillae." 

Lyra, Abulensis, Gregorius, Sanctius, and other distinguished and learned com- 
mentators, think that the Philistines, besides being afflicted with haemorrhoids or 
piles, had their intestines to emerge, hang down, and at length putrify. The Latin 
text of the ninth verse has "Et computrescebant, prominentes extales eorum." — 
and their projecting entrails became putrid. The Hebrew has for extales " Apho- 
lim," and represents that the " Apholim," or vicious tumors, were hidden, or 
unknown to them, which Vatablus and Rabbi David (and even Isidorus, seemingly) 
explain to mean, that the plague of piles or haemorrhoids, was again drawn into 
the interior of the body, and thus hidden. 



60 HEMORRHOIDS — PILES. 

ever noticed is the division of these swellings or tumors into 
sanguineous and serous — that is, into those which arise from 
a deposition of blood, and those which arise from a de- 
posit of serum, beneath the skin. The former are opaque 
and of a comparatively dark color, the blood often evidently 
shining through the skin. They are generally of a firm con- 
sistence and of slow formation : the latter are of a pale color, 
almost transparent, highly elastic, easily compressible, soon 
produced and most always external. The sanguineous, or 
those produced by a deposit of blood, usually occur in the 
strong and the healthy ; whereas the serous, or those pro- 
duced by a deposit of the watery portion of the blood, are 
more apt to arise in the weak and the irritable. The best divi- 
sion, however, and that having the most practical bearing, is 
into functional and structural ; or, in other words, into acci- 
dental and permanent. 

"Whatever opinions may be entertained, and they are 
indeed many and various, with regard to the essential nature 
of these tumors, yet all agree that sooner or later, their con- 
tents coagulate — they become solid, and their coats increase 
in thickness; changes, which greatly modify and obscure 
their first organic alteration. These are what we call perma- 
nent or organized tumors. The accidental or primary tumors 
are generally easily compressible : and at an early stage, can 
be easily made to disappear altogether by proper means. 
Persons who labor under this kind of piles, may, for months, 
feel no uneasiness whatever ; but at length, from some cause, 
they will take what they call " a fit of the piles." They will 
suffer the most excruciating pain when stooling, and for 
several hours after — caused chiefly by the involuntary and 
violent spasm of the sphincter muscle on some of the tumors 
about the anus. There will sometimes be a coldness, or lan- 
guid circulation in the extremities, especially in the lower; 
nervous or neuralgic pains in the head, neck, and alone- the 



HEMORRHOIDS— PILES. 61 

spine ; sometimes attended with vertigo — dull throbbing pain 
in the rectum, with increased heat, straining and mucous 
discharge ; palpitation of the heart ; a feeling of weight in 
the back, hips and groin ; weight and pain in the forehead ; 
flatulence, scanty and high colored urine, with a frequent 
desire to avoid it and fasces ; sometimes there is profuse 
bleeding. These attacks generally continue four or five days, 
and then disappear, as suddenly as they came on ; leaving 
nothing where the tumors were, but some shrivelled mem- 
brane. 

The permanent or organized piles, produce, in many instan- 
ces, a degree of inconvenience which interferes most seri- 
ously with the active duties of life. Itching of the anus, is, 
perhaps, one of the earliest symptoms ; a sense of heat and 
fullness of the rectum ; sometimes fever and great local unea- 
siness ; the patient will suffer the most severe agony whilst 
stooling, and the tumors, whether internal or external, will 
become swollen, tense and extremely tender ; so that they 
can scarcely be touched ; they sometimes have quite a pulsa- 
tion in them. When the internal tumors are much swollen, 
they will fill up a large portion of the cavity of the bowel, 
and excite a sensation as if some foreign substance was in it. 
Sometimes the tumors bleed profusely, which immediately 
relieves all the local pain and irritation : sometimes, however, 
they bleed more or less at each evacuation of the bowels, 
without affording but partial relief. The haemorrhage usually 
occurs during defecation, but may, however, take place either 
before or afterwards. The appearance of the blood is of a 
bright vermilion color ; it is fluid, and usually runs in a 
stream, the amount lost at each stool, varies from a teaspoon- 
ful to a pint. I have seen patients having neither internal 
nor external tumors, discharge several ounces of blood at each 
evacuation of the bowels, and experience no pain or uneasi- 
ness whatever. When the bleeding once takes place in a 



62 HEMORRHOIDS— PILES. 

patient, it almost universally returns, and the repeated losses 
of blood progressively lessen the powers of the system, and 
introduce habits which, unless promptly attended to, often result 
in the most serious consequences. The haemorrhage sometimes 
takes place at every protrusion of the tumors, the blood being 
projected in continuous jets, from the round openings in the 
ends of one or more of them, and is often so profuse as to 
occasion fainting, and even to imperil life by the mere loss 
of blood. 

When the bleeding takes place from the intestines high up, 
it is manifested by the blood being black, coagulated and 
mixed with the faeces ; whereas, when it takes place in the 
rectum, and from piles, it is never mixed with, but may cover 
the faeces, and is fluid. This is important and should be 
remembered. 

In cases of excessive haemorrhage, and especially when it 
becomes habitual, the constitution sooner or later suffers, and 
a train of unpleasant symptoms arises. The complexion of 
the patient becomes sallow and dingy, and presents a peculiar 
tallowy or waxy appearance ; his countenance is always pale, 
heavy and bloodless ; his eyelids are puffy ; his lips and gums 
are blanched ; his tongue is pale and semi-transparent ; his 
pulse is quick, weak and jerking ; his breathing is difficult, 
particularly when ascending steps ; the heart's action is easily 
excited, and palpitates violently, by either slight bodily exer- 
tion, or mental agitation ; he frequently suffers from head- 
ache, especially when sitting up, which, is most always 
entirely or partially relieved by the horizontal posture ; his 
sleep is disturbed ; his temper becomes irritable and peevish ; 
he is listless, and a deficiency of physical and mental energy 
supervenes ; and finally as the result of his anaemic, or blood- 
less condition, cedematous or watery swellings of the extremi- 
ties take place. 



HEMORRHOIDS— PILES. 63 

Extraordinary cases of Haemorrhage from Piles, 

Numerous and well authenticated cases might be cited to 
prove that death has often been caused by the mere loss of 
blood from haemorrhoids. Bordeu as well as Benj. Bell, 
mentions cases of this kind. It is said that both Arius and 
the celebrated philosopher Copernicus perished from this 
cause. The quantity of blood that sometimes escapes in cases 
of this kind, is very great ; yet I have never seen such a case, 
that the patient's general health was not at once most seri- 
ously affected by it. Many writers, however, have related 
cases, in which, notwithstanding, there was an enormous dis- 
charge of blood daily ; yet these persons continued to enjoy 
excellent health, which would appear almost incredible. The 
relation of such cases, however, should in my opinion, be 
received with a considerable degree of allowance, as the 
amount of blood lost, is doubtless often greatly exaggerated. 
Patients are exceedingly apt to imagine the haemorrhage to be 
much more profuse than it really is, from the alarm which is 
generally caused by the mere sight of blood ; the great show, 
too, which even a small amount of blood makes on the linen 
and cloths, and its admixture sometimes with other fluids, 
also imposes on their imagination or inexperience. 

Montanus, according to the report of Schwevcher, saw a 
patient who had passed two pounds of blood for forty-five 
successive days, and finally recovered. (Append. Cansilior 
Montani, p. 59, Basil, 1588). Cornarius mentions the case 
of a gentleman, who after drinking freely of Hungarian 
wine, lost two pounds of blood from the nose, and six pounds 
on each of the four following days from the anus. Never- 
theless he got well without any remedy. (Olserv. Med. 26.) 
Pomme gives the case of a man thirty-six years of age, of an 
atrabilious temperament, who for a long time had been sub- 
ject to an excessive haamorrhoidal flux, for which he tried 



64 HEMORRHOIDS — PILES. 

many remedies without obtaining relief. At length, having 
adopted the idea that it had a venereal origin, he underwent 
an antisyphilitic course of treatment, in consequence of which 
the flux disappeared. However, he w T as soon attacked with 
distressing symptoms of cholera, when the haemorrhage reap- 
peared. During a month he lost nearly a pound of blood 
daily, which was followed by colic, pains of the face and 
extremities. By a generous diet, nutrient injections, and 
cold baths, the haemorrhage was arrested, and exercise on 
horseback rendered him convalescent. (" Traites des Mala- 
dies Vaporeuses") Lanzoni cites, the case of a priest who 
daily passed a pint of blood per anum. (Consult. Med., 97. 
Oper., tome ii. p. 203.) Ferdinand says that a girl twenty 
years of age, of a sanguineous temperament, sedentary 
habits, and endowed with much vivacity, in consequence of 
a violent chagrin, arising from jealousy, became affected 
with haemorrhoids, and for many months daily evacuated 
about half a pint of blood while at stool. The menstrual dis- 
charge ceased, her face became pallid and ©edematous. Under 
proper treatment, she perfectly recovered. (Hist. Med., 16, 
p. 40.) Panarola knew a Spanish nobleman who, for forty 
years, rendered each day a pint of blood per anum, and at 
the same time enjoyed perfect health. (Observ. Med.,penteo. 
ii., Obs. 46.) Harris saw a widow of meagre frame and 
bilious temperament, lost upwards of four pounds of blood 
from haemorrhoids in a few hours; during the night, she 
nearly died from exhaustion. However the bleeding was 
arrested by the application of cloths soaked in spirits of 
wine. (De Morbis Alig., Gravior. Obs. x.) Bozelli men- 
tions the case of a tailor, who lost as much as ten pounds of 
blood at a time. This man was nevertheless vigorous, and of 
a jovial character. Bozelli diminished this flux by means of 
the syrup of roses. (Observ. Med., 44.) Spidler saw a pot- 
ter, w T ho after having suffered for a week with pain in the 



HEMORRHOIDS— PILES. 65 

loins, was seized with violent colic, and severe vomiting. A 
cathartic was administered, which relieved him ; but he 
passed from twelve to fourteen pounds of vermilion colored 
blood from the anus, in twenty-four hours, each dejection 
being accompanied by a slight colic pain. After many 
remedies were tried in vain, the haemorrhage was arrested by 
a stimulating injection. Hoffman says he saw a widow, fifty 
3 T ears old, of a very full habit, who, in consequence of an 
indolent course of life and full living, was, for eight years, 
subject to haemorrhoids ; at the same time she continued to 
menstruate. The uterine discharge having ceased, and being 
blooded but once, she was seized towards the autumnal equi- 
nox, first with- lassitude, and then with coma, for which she 
was bled in the foot, and took cold water in large quantities 
without any benefit. At the end of two days, however, a 
stimulating lavement was administered, when an excessive 
flux of blood occurred, amounting in twenty-four hours to 
more than twenty pounds ; the consequence of which was a 
cessation of the coma. Her strength gradually returned by 
the employment of invigorating and gently astringent reme- 
dies, together with enemata of cold water. Smetius relates 
a case of a man forty years of age, who passed per anum at 
least thirty pounds of blood in two or three days. He was 
cured by a tonic plaster. (Miscel. Med. 1, 4, JEjristol. 9, p. 
222.) Pezold speaks of a Saxon chevalier, who in one attack, 
lost sixty-four pounds of blood. (Obs. Med. Chir., 51.) 

Dr. Bushe, from whose valuable work on diseases of the 
rectum, I have selected the preceding cases, says that^ 
" There can be no doubt in the mind of any rational man^ 
but that these statements abound with exaggeration." 

Mucous Discharge Consequent upon Piles, 

A mucous discharge is a very frequent and a very annoy- 
ing accompaniment of the haemorrhoidal disease; it varies- 



6b HEMORRHOIDS — PILES. 

much, both as to quantity and appearance. When there is 
an active or high state of irritation of the mucous membrane 
of the anal canal, caused by piles, the mucous secretion is 
watery, resembling a thin solution of gum arabic ; it is often 
quite acrid, producing excoriation of all the surrounding 
parts with which it comes in contact ; it constantly exudes 
from the anus soiling the patient's linen, and sometimes even 
running down his legs ; and often constitutes the chief source 
of his discomfort. When, however, there is a chronic irri- 
tation of the mucous membrance existing, the secretion is 
gelatinous in appearance and resembles the white of an 
unboiled egg, or frog's spawn. If the discharge is tenacious 
and moderate in quantity, it is passed at stool only ; but if 
it is profuse, any exertion, such as walking, running, riding 
either on horseback or in a carriage, and even laughing, 
coughing and sneezing will cause its ejection. I might have 
said that it sometimes resembles currant jelly in color. 

The Form, Size, Color and Density of Piles. 

Hemorrhoidal tumors vary very much in form, size and 
color. When they are highly inflamed, they are red or pur- 
ple, tense and hard ; but when they are in an indolent condi- 
tion, they are more or less pale and flaccid. Some are hardly 
larger than a pea, whilst others exceed a hen's egg in size. 
They generally have a broad base, but sometimes they are 
pedunculated. Pile tumors sometimes have the form and 
appearance of strawberries, mulberries, raspberries and large 
purple grapes. 

Brodie's Description of Piles. 

The eminent Sir Benjamin Brodie describes the hsemor- 
rhoidal disease in the following manner. He says that, " The 
veins of the anus, at first become simply dilated ; repeated 
attacks of inflammation cause an effusion of lymph into the 
adjacent cellular texture ; and then the pile appears like a 



HAEMORRHOIDS — PILES. 67 

solid tumor." He continues further to remark — " A patient 
consults you, complaining of swelling, pain and tenderness 
in the neighborhood of the anus. You examine the part, 
and find on its verge a number of tumors, about the size of 
the end of the thumb or finger, with broad bases, not very 
distinct from, but running one into the other, covered by the 
common integuments, and of a more or less purple appear- 
ance. If you cut into one of these tumors, there is immedi- 
ately a flow of venous blood, such as might arise from a cut 
anywhere else. On making a section of the tumor, it pre- 
sents to the eye the appearance of dilated and tortuous veins. 
In fact you cannot doubt, that they are dilated veins ; they 
are exactly like varicose veins of the leg. The tumors I have 
described, are situated below the sphincter muscle, and we 
call them external piles." Of internal piles, the same author 
observes, " Another patient consults you, complaining also 
of a swelling at the anus, accompanied by pain and tender- 
ness. You examine the part, and find a number of tumors 
of a different kind. These too have broad bases, and run 
one into the other, forming a circle which projects below the 
anus. They are covered, not by the common integument, but 
by the mucous membrane of the rectum, protruded from 
above the sphincter muscle. On making a section of one of 
these tumors, there immediately flows venous blood, and ar- 
terial blood may flow afterwards. On looking at the divided 
surface, it is evident that the tumor was composed of a large 
tortuous vein. It is the accidental enlargement of these 
tumors, which causes them to protrude externally ; but they 
are formed above the sphincter muscle, and we call them 
internal piles, or haemorrhoids." — (Clinical Lectures on Sur- 
gery,p. 306. Philadelphia, 1846). 



68 HEMORRHOIDS— PILES. 

The Causes of Hemorrhoids, 

The causes of hemorrhoidal affections are multifarious, 
but they all doubtless act much in the same manner — that 
is, by preventing or retarding the free return of blood from 
the inferior mesenteric vein. They may all be classed into 
predisposing and exciting. 

Among the predisposing causes may be named the peculiar 
dependent situation of the hemorrhoidal veins ; hereditary 
disposition ; a morbid condition of the digestive organs ; 
age ; sex ; climate ; period of year, &c. 

I have elsewhere shown the dependent position of the veins 
of the extremity of the rectum, their comparatively large 
size, the little support they receive from the loose cellular 
membrane of the anal region, and their entire destitution of 
valves. The blood gravitates to the rectum whenever the 
body is erect; so that, under the most favorable circum- 
stances, these veins are exposed to more strain and pressure 
than any others of the body ; in consequence of their absence 
of valves, the whole weight of the column of blood in them 
reaches from the liver or the heart, without interruption 
downward. The main channel again, for the return of the 
blood from the bowels, is through the liver, and it is scarcely 
necessary to observe, that every disturbance of the functions 
of that organ acts as an impediment to the passage of the 
blood through it, and tends in the same degree to increase 
congestion of the vessels of the lower bowel. These several 
circumstances dispose those vessels to become gorged and 
dilated with fluids from the slightest exciting causes ; and 
thus lay the foundation of this troublesome and painful 
disease. 

A hereditary tendency to this complaint is often traceable. 
I have seen, children of hemorrhoidal parents whose ages 
varied from six months to six years, who had piles, a very 



HEMORRHOIDS— PILES. 69 

unusual age for the appearance of the disease ; thus proving 
the early manifestation of the hereditary predisposition. 

It is a fact that cannot be controverted that a similarity of 
conformation of the parts, favorable to the development of 
the disease may be transmitted from father. to son, and which 
may contribute indirectly to the production of haemorrhoids, 
by favoring the operation of any exciting causes that might 
at any time exist. Whether there is, or is not, however, a 
general predisposition inherited, independent of the particu- 
lar structure of the parts, is a question I am not so well pre- 
pared to answer. 

A disordered state of the digestive organs, with its conse- 
quent train of evils on the lower viscera, is a frequent pre- 
disposing cause of the hemorrhoidal disease. 

Mature age is that in which the hemorrhoidal affecti: u 
usually manifests itself. It is at this period of life that the 
anal region is peculiarly susceptible of sanguineous engorge- 
ments ; the venous system is fully developed, and the circu- 
lation is less rapid ; the bilious temperament and the 
depressing passions also pertain, for the most part, to those 
of this age. In early life the head and chest are the parts 
of the body that are most subject to vascular repletion. Of 
upwards of two thousand cases which came under my imme- 
diate and especial notice, I ascertained to a certainty that in 
three fourths of them, the disease had manifested itself 
between the ages of thirty-five and forty-eight. 

Males are doubtless much more liable to the hemorrhoidal 
disease, than the other sex, and this is in accordance with 
my own experience ; yet it is a question concerning which 
there has been considerable diversity of opinion. The dis- 
ciples of the celebrated Stahl maintained that the male sex 
is much more frequently affected with the piles than the 
female, and this is in accordance with what, physiologically 
speaking, might be expected ; for the menstrual discharge 



70 



HEMORRHOIDS— PILES. 



peculiar to the latter would appear to be sufficient, so long 
as it continues, to completely relieve the system of any super- 
fluous blood. Many eminent medical men, however, are of 
opinion, that females are much more liable to this affection 
than males. Be this as it may, one thing is certain, and that 
is, that females, at two periods of their lives, are more liable 
to haemorrhoids than males — namely, during pregnancy, and 
at the cessation of the menses. In this latter case the fre- 
quency of this disease may be attributed to the change that 
has taken place from the suspension of an important func- 
tion ; in the former case, to causes that act mechanically, 
and whose operation is evident — namely, to the pressure, in 
part, of the foetus, in advanced pregnancy, against the blood 
vessels. 

It is by no means unusual for females to have, at each 
menstrual discharge, an attack of piles, both coming on 
simultaneously, and both subsiding together in a few days. 
I have seen cases in which the menstrual discharge had 
ceased for several months, and the patient during the time 
had regular periodical attacks of bleeding piles, which 
appeared, for the time being, to be a complete substitute for 
the menses. Sometimes the menstrual discharge and the 
hemorrhoidal, regularly alternate with each other. 

The spring of the year is the period considered most favor- 
able for the development of the hsemorrhoidal disease, for it 
is during this season that the mass of the blood is always 
increased, in consequence of the secretions during the winter 
having been diminished ; and the absorption of caloric, it is 
well known, expands the blood. At this delightful season, 
too, the whole phenomena of life are most active. 

Many are of opinion that warm climates dispose to the 
hsemorrhoidal disease. The celebrated Montegre believed 
that they operated by inducing the bilious constitution. 
This is doubtless true, especially with regard to those who 



HEMORRHOIDS — PILES. 71 

leave the north and reside for several years in a southern 
climate — such are extremely liable, sooner or later, to be 
afflicted with piles. I have, however, been much surprised 
at the large number in the northern portion of the United 
States, who are suffering from this disease. It is accounted 
for, by some, to the very severe and changeable weather of 
the north, and attributable to the accumulation of blood in 
the internal organs, when the surface of the body which has 
been hot, becomes rapidly chilled down by the sudden 
reduction of the temperature. The nature and the tempera- 
ture of the atmosphere, it js evident, have no inconsiderable 
influence in combination with other causes, in the production 
of haemorrhoids ; but I am of the opinion that this influence 
bears no comparison to the circumstances with which it is 
connected — namely, the peculiar character of the food of 
which the inhabitants of different nations, or parts of coun- 
try, partake, and the peculiar manners, customs and habits 
to which they are subjected. 

Among the principal exciting causes of haemorrhoids, 
or those which have an immediate and direct opera- 
tion, may be classed the following: — A torpid, and con- 
sequently a constipated state of the bowels. The circu- 
lation of the blood in the capillary system of the intes- 
tines, is very materially aided by the peristaltic motion 
of the bowels, especially of the rectum ; hence, when- 
ever this action is less than natural, it gives rise to local 
irritation and congestion in various ways, and results in the 
disease in question. When the faecal matter is long retained 
in the colon, or the rectum, it becomes altered in respect to 
its chemical properties, so as to produce very great irritation 
of the mucous membrane, and thus cause an afflux of blood 
toward it. The faeces also, in these cases, often become 
exceedingly indurated and impacted, in consequence of 
which the free current of the blood is greatly interrupted by 



72 



HEMORRHOIDS — PILES. 



the compression they produce upon the hemorrhoidal veins ; 
the violent and prolonged efforts at their expulsion, too, force 
down the mucous membrane of the rectum, and engorge with 
blood its vessels. 

The frequent use of purgatives, such as act chiefly upon the 
rectum, produces great irritation. Aloes, colocynth, scam- 
mony, gamboge, calomel and salts, are among those purgatives 
which occasion the greatest influence upon the vessels of the 
rectum. The irritating effects of aloes are such, that even a 
moderate dose will almost invariably produce the piles. The 
frequent use of warm, as well as stimulating rectal injections. 
The introduction into the rectum of suppositories composed 
of irritating substances. Worms nestling in the rectum. 
Irritating applications to the anus after stooling. Filthiness 
of the anal region. Constant sitting. Violent horseback 
exercise. Lifting heavy weights. Sudden and violent ex- 
ertion. Dysentery. Diarrhoea. Development of tumors in 
the vicinity of the end of the rectum. Prolapsus of the 
womb. Prolapsus of the rectum. Enlargement of the pros- 
tate gland. Stricture of the urethra. Stricture of the rec- 
tum. Stone in the bladder. Hernia. Tight lacing. Sitting 
much on pierced seats is the occasional cause of -this affection. 
Such seats not only leave- the anus unsupported, and allow 
the blood to. gravitate without resistance, but in consequence 
of the pressure on the surrounding parts, the circulation is 
obstructed. The continued use of high-seasoned and stimu- 
lating food. The free use of the heading wines, such as 
champagne, &c. The intemperate use of spiritous drinks, 
generally. Hurried and excessive straining efforts at stool, 
is quite a frequent cause of piles. The application of leeches 
to the anus. Local irritation produced by disease in some 
other part of the body. The passions, rage, fear, sorrow, 
restlessness, ennui, &c, also powerfully influence and keep 
up this disease. Sedentary habits tend greatly to the pro- 



HEMORRHOIDS — PILES. 73 

duction or haemorrhoids ; hence the disease is much more 
common in the higher classes of society, owing to their free 
living and their sedentary habits. They generally take but 
little exercise, and hence are more liable to constipation of 
the bowels. The lower classes live on simple diet, and take 
much exercise in the open air. 

Mr. Calvert, who travelled both in Greece and Turkey, 
says that, " The great frequency of hemorrhoidal diseases 
among the Turks, may be traced to the indolent habit of sit- 
ting, during almost the whole day, on warm, soft cushions ; 
to the peculiarity of their diet, which in addition to their 
general habits, often produces an indolent and torpid state of 
the bowels ; and, perhaps, also to an excessive indulgence in 
venery." (A Practical Treatise on Hamiorrhoids, <&c. By 
George Calvert, M.D.,p. 60. 1824.) "Hoffman, who prac- 
tised forty years in Saxony, observes that hsemorrhoidal 
affections had greatly increased in his time, from the pro- 
gress of luxury and the increase of idleness and sedentary 
habits. A confirmation of this remark is found among peo- 
ple who have led an active life, till a certain period of life, 
when, on leaving off business, and indulging in repose, they 
have become, for the first time, affected with piles." (Medico- 
Chirurgical Review >, Vol. VI.,p.2S6. April, 1825.) 

These are some among the frequent and familiar agents in 
producing piles. Many of these causes, however, which, in 
excess, produce the hsemorrhoidal disease, or dispose to it, 
may, if applied with moderation and judgment, contribute 
very materially to their prevention and cure. 

Diagnosis of Piles. 

The diagnosis of this disease is by no means difficult ; yet, 

strange to say, almost every disease of the anus and rectum 

is confounded with it, or termed piles, by a large majority of 

persons — many even in the profession. It is, therefore, highly 



74 HAEMORRHOIDS — PILES. 

important to know how to distinguish the hemorrhoidal dis- 
ease from all others of the same parts, as the want of such 
knowledge often leads to the most serious results. JSTo person, 
however, who will read this chapter carefully from begin- 
ning to end, need ever make this mistake. Hemorrhoidal 
tumors are more liable to be confounded with prolapsus 
of the rectum, polypi of the rectum, and enlargement 
of the prostate gland, than any other diseases of those 
parts. 

A pile is an accidental growth, such as I have already 
described, attached almost always internally to the lining 
membrane of the rectum, but entirely distinct from, and in 
no wise involving it, as can be demonstrated at any time by 
making the examination when the lining membrane is in its 
natural situation, being neither elongated nor everted. 

There is one peculiar form of prolapsus of the rectum 
which would most likely be mistaken for piles, and that is 
the one in which there is a flap of membrane protruded on 
each side of the anus, and which, from their having been 
forced down and up so often, have become quite thick, rough 
and sometimes even hard. However, the semi-lunar form of 
these flaps, the extent of their base, and their entire freedom 
from sudden erection or collapse, are characteristics so oppo- 
site to those which have been described as pertaining to 
piles, that even a superficial examination will enable any one 
to distinguish between them. For a full description of pro- 
lapsus of the rectum, see the chapter on that disease. 

Polypi of the rectum very much simulate piles; and may 
be distinguished from them, by their very soft, delicate and 
spongy feel, their very pale red color, their incapability of 
sudden erection or collapse, and their very slow growth. For 
a full description of polypi of the rectum, see the chapter on 
that disease. 

Enlargement of the prostate gland may also be mistaken 



HAEMORRHOIDS — PILES. 75 

for a hemorrhoidal tumor. It may be easily distinguished, 
however, by inserting the finger into the rectum, when the 
enlarged gland will be distinctly felt, just behind the neck of 
the bladder, as a hard, firm and immovable body. 

Should Hemorrhoids be Radically Cured f 

It was the opinion anciently, that haemorrhoids were a 
salutary provision of nature; an effort of the vis nature 
medicatrix^ for the advantage of the constitution ; hence their 
cure or suppression was very much dreaded. Many of these 
notions, it is true, have long since passed away ; yet it is 
astonishing how many are still 'advocating them. But inas- 
much as it is a most painful and disagreeable disease, arising 
in most cases from known local causes, the cure of it should 
not by any means be delayed even a day or an hour, as it is 
so very liable at all times, to cause or terminate in, some 
other more serious disease, such as fistula in ano, of which I 
have seen numerous cases ; ulceration of the rectum ; pro- 
lapsus of the rectum ; stricture of the rectum, a most dread- 
ful disease. Sometimes it produces the most obstinate leu- 
corrhoea (fluor albus) ; also, fissure of the anus, one of the 
most painful diseases of these parts. I have seen the most 
violent paroxysms of neuralgia of the anus and of the spine, 
caused by the piles ; and even cancer of the rectum may be 
caused by an old indurated pile tumor. 

Let no one then persuade the unfortunate who are suffer- 
ing from this disease, that their painful and disagreeable 
infirmity is a salutary emunctoiy — a "safety-valve" and the 
very guarantee of health. Such a doctrine, as a general rule, 
when applied to this disease, is highly pernicious, and often 
leads to the most serious and fatal consequences. 

Although I have recommended that the cure of piles should 
not be delayed, for the very best of reasons, yet there may 
be some few exceptions, cases in which it might not be pru- 



76 H^MOREHOIDS — PILES. 

dent to meddle; those for instance, who have a regular peri- 
odical bleeding, much like the menses in women, who are not 
too much debilitated by it, nor injured in their general 
health in other respects. In such persons it might not be 
prudent to suppress it, as it may, perhaps, supply some other 
evacuation which nature either ceases to carry on, or does 
not furnish in due quantity. It would also be imprudent to 
interfere with this disease in persons in whom it has appeared 
suddenly, on- the suppression of either of the following 
haemorrhages, epistaxis, (bleeding from the nose) ; haemopty- 
sis, (spitting blood, or bleeding from the lungs) ; hcemateme- 
sis, (vomiting blood, or bleeding from the stomach). If in 
either of the preceding haemorrhages, the patient is improved 
by the supervention of haemorrhoids, then they should not be 
interfered with. The same rule will apply in all cases where 
there is a full, plethoric habit, and a predisposition to apo- 
plexy, to headache, and to vertigo. In females, too, who 
have ceased to menstruate, especially those of a plethoric 
habit, the system sometimes immediately after, becomes sur- 
charged with blood. If, under such circumstances the bleed- 
ing piles should supervene, the haemorrhage might be looked 
upon as a fortunate circumstance, as it might in this way be 
the means of warding off the attack of some more serious dis- 
ease. The piles, however, in any of those cases, should they 
have been cured, can very easily be reproduced, if desirable, 
by resorting to some of the numerous patent pills of the day, 
as they all contain more or less aloes and other drastic 
ingredients. 

Equitation and Cold Water as Preventives of Piles. 

The celebrated surgeon Baron Larrey, of France, highly 
recommended horseback exercise as a preventive of the 
haemorrhoidal disease. I have myself witnessed the most 
happy effects of the same exercise, in several instances. TIiq 



HEMORRHOIDS— PILES. 77 

patients were greatly troubled with congestion, or fulness of 
the blood-vessels of the anal region, and predisposed to 
haemorrhoids. The pressure of the saddle in these cases, 
appeared to exert a most salutary influence in removing the 
congestion. I doubt, however, whether any confirmed case 
of haemorrhoids could be radically cured by horseback exer- 
cise alone. At least I have never seen such. I have also 
witnessed the good effects of cold water applied to the parts 
in the form of an ascending douche, both as a preventive and 
a palliative in this affection. But neither of these most 
pleasant means are generally sufficient of themselves to effect 
a radical cure of the disease, which should always be the first 
consideration of the patient and the surgeon. 

" It was long an opinion among the ancients and moderns, 
that riding on horseback was prejudicial to haemorrhoida- 
rians. The fact is just the reverse. There is not a more certain 
'preservative from piles, than regular horse exercise. But if 
a person unaccustomed to equitation, takes this exercise in a 
sudden and violent manner, especially if he have the piles in 
the least protruded at the time, then he may suffer from what 
at another time, and more judiciously managed, would prove 
an excellent preventive. This fact is substantiated by our 
cavalry surgeons — and we need only refer to the testimony 
of Baron Larrey on this subject, for ample proof of the posi- 
tion laid down. Larrey was long in the habit of causing sol- 
diers affected with piles, to ride on horseback at full gallop ; 
and he avers that he never saw any bad effects follow, but 
generally on the contrary, the most salutary consequences." 
{Medico Chirurgical Review, vol. VI. Jan. — April, 1825, 
p. 289.) 

The talented and lamented Montegre, in his invaluable 
treatise, has also recommended horse exercise in moderation, 
as a powerful means of preventing and curing haemorrhoids. 
He also recommended cold water, either as a lotion, a 



78 HAEMORRHOIDS— PILES. 

"douche ascendante" or an injection, as a preventive and 
sometimes as a cnre. He gives two cases that were cured by 
the " douche ascendante" which is throwing water forcibly, 
by means of a syringe, against the anus. 

Case 1. A man thirty-four years of age, of good constitu- 
tion, but hsemorrhoidinary from an early period, had during 
the last few years, experienced long and painful attacks of 
the complaint under consideration. The last attack had now 
continued three months, without any relief from pain, though 
a great number of remedies had been used in vain. Each 
evacuation was followed by the excruciating pains already 
described, so that the poor man was often deprived of sleep 
for whole nights together, was reduced to despair, and almost 
entirely abandoned' food, for fear of the sufferings attendant 
on the evacuation of the fasces. In this state, he commenced 
the use of the "douche ascendante" by means of a syringe 
with a crooked pipe. The first effect of this application, was 
a diminution of the pains, and a reduction of the hsemor- 
rhoidal tumors, so as to be reducible within the sphincter. 
The process was continued for three or four days, and the 
pains ceased entirely. He has now been five years free from 
complaint. 

Case 2. A man forty years of age, of plethoric constitu- 
tion, had been ten years affected with internal piles, without 
any* discharge. A sedentary life, without any regular rest 
for some months, had caused an hemorrhoidal swelling, 
attended by inflammation, and finally by ulceration. To 
this state was added the excruciating pains in question. 
Having a water-closet of English construction, he contrived 
to have the jet of water thrown against the anus, which gave 
him instant relief, for a time. He renewed the application 
every time the pain came on, which was sometimes very often 
in the twenty-four hours, and always with the same effect. 



HEMORRHOIDS— PILES. 79 

By persevering in this plan a month, or six weeks, the ulcer- 
ations healed, the haemorrhoids disappeared, and the pains 
ceased. — (Pes Hemorroides, ou Traite Analitique de Toutes 
les Affections Hemorroidales, Deuxieme edition, Paris, 1830.) 

Medical Treatment of Piles often Empirical. 

One would suppose that so ancient and so common an 
affection as the one under consideration, one which causes so 
much suffering, too, and one which is constantly falling 
under the immediate observation of every physician, would 
at this day be well understood by the profession generally ; 
that every thing in relation to its anatomical characters, its 
pathology and its treatment, would be clearly made out, and 
well defined. But, in reality, the very reverse of this hap- 
pens to be the truth. So far at least, as the medical treat- 
ment is concerned, it always has been, and still is, to a great 
extent, highly empirical; and frequently no better reason 
can be given for the use of a remedy, than that it has some- 
times succeeded. Hence the multitudinous, contradictory, 
and useless means now resorted to, for the cure of piles. The 
category of the mere medical measures of the present day, 
for the cure of this disease, I have neither time nor inclina- 
tion to sum up. The following, however, are a few of them : 
the ointment of galls, and a thousand and one other salves ; 
"Ward's paste ; Hay's liniment ; various kinds of supposito- 
ries ; cream of tartar and flour of sulphur ; aloes ; Upham's 
Electuary, &c. &c. It is true that some of these means may 
occasionally afford relief, at least temporary, but they never 
cure the disease ; they never remove the cause ; and should 
the patient get well, it would certainly not be owing to the 
remedy. In all cases in which the hsemorrhoidal tumors are 
regularly organized, of long standing, are either indurated, 
ulcerated, or are the source of excessive haemorrhage, it is 
from the surgical treatment, that the greatest amount of good 



80 HEMORRHOIDS — PILES. 

is to be experienced. Medical means, or general treatment, 
may sometimes remove the disease in its early and forming 
stage, but it is chiefly to surgical measures that the patient 
will ever be indebted for a complete and radical cure of his 
disease. 

Superstitious Treatment of Haemorrhoids. 
Yarious superstitious notions, such as charms, incantations, 
invocations, &c, have also from time to time been put into 
requisition for the cure of piles, doubtless owing to the usual 
empirical practice in this affection. Monardes mentions the 
lapis sanguinaris, (blood stone,) found in Mexico, as being 
put in rings and worn on the fingers of those who were 
afflicted with haemorrhoids, for their relief. Yan Helinont 
affirms that he had a metal, of which, if a ring were made 
and worn, not only the pain attendant on haemorrhoids would 
cease, but that in twenty-four hours, whether internal or ex- 
ternal, they would vanish altogether. When the practice of 
medicine was confined to priests and monks, as it once was, 
particular diseases were appropriated to particular saints ; 
indeed, at one time, the whole divi and divce of Catholicism, 
were exercising the benevolence of divine power in the cure 
of diseases, especially during the prevalence of such as 
excited forcibly the fears of men. Not a saint, male or 
female, of the Christian calendar, could then have been 
named, who had not been invoked, and if we believe their 
votaries, successfully too, for the cure of diseases. Among 
the numerous medical saints of those times, was the celebra- 
ted Saint Ficarius, who was famous for curing the piles, as 
well as all other diseases of the anus. In our own enlight- 
ened day and age, the horse-chestnut, or buck-eye, fruit of the 
jEsculuS) is carried about the persons of those who have 
piles, for their cure. I have often been astonished to hear 
intelligent persons extolling, in the most eloquent manner, 
the superior virtues of this divine remedy. The stock of ere- 



HEMORRHOIDS— PILES. 81 

dulity, however, in this world is inexhaustible. In the spring 

of 1850, I cured Mr. J. L. T , of New Orleans, La., aged 

fifty-five years, of a fistula in ano, and removed three large 
hemorrhoidal tumors of twenty years standing. After I 
had cured him, he presented me with two Spanish Buckeyes, 
as he called them, which he had carried in his pockets fifteen 
years, and for which he had paid five dollars apiece. He 
still maintains that, although the buckeyes did not cure the 
piles which resulted in a fistula ani, yet they entirely relieved 
the pain ever after, from which he suffered in the early stage 
of his disease. These two buckeyes I now have in my cabi- 
net as curiosities. Their cuticle is worn, by long use, quite 
thin, and as smooth as glass or ivory. 

Excision and Cauterization of Hemorrhoidal Tumors. 

Excision with the knife or scissors, as well as cauterization 
with the red-hot iron or caustic, is, at the present day, prac- 
ticed by some surgeons for the removal of piles. 

As it regards the removal of internal hasmorrhoidal 
tumors, either with the knife or the scissors, I would remark, 
that it is an exceedingly dangerous operation, and should 
never be performed. It has been discountenanced by some 
of the most able surgeons in the world. Indeed, not one 
patient in a hundred would submit to this operation, were he 
to be made acquainted with the serious danger of haemor- 
rhage that always must attend it. The great Sir Astley 
Cooper stamped his reprobation upon it, by relating several 
disastrous and fatal cases which came under his immediate 
notice; one, the case of a Scottish nobleman, will be given 
in his own language. He says, " As I was anxious about this 
patient, I did not immediately quit the room after the ope- 
ration, but stood chatting with him for a short time, when he 
said, 1 1 believe you must quit the room, for I must have a 

motion? I went out of the room, and upon returning shortly 
6 



82 HJEMORBHOIDS — PILES. 

after, I found him trying to get into bed ; and upon looking 
into the vessel, I perceived a considerable quantity of blood 
in it. In a few minutes after he said he must have another 
motion, got out of bed, and again discharged a considerable 
quantity of blood. This he did four different times ; one of 
the hemorrhoidal arteries in the centre of one of the piles 
which had been removed, was divided ; and as I was deter- 
mined he should not die of hemorrhage, I said I must secure 
the vessel which bled, and with a speculum ani, I opened the 
rectum sufficiently to see the blood-vessel, took it up with a 
tenaculum, and put a ligature around it. The patient, how- 
ever, became gradually worse, and died in four days." A 
similar case is thus related by him : " Mr. Esdaile came to 
London from Guernsey or Jersey, in order to have a hemor- 
rhoid removed. Mr. Leman and I attended him, and I 
removed a single pile by scissors. On the following day he 
was exceedingly low, his pulse small, so as to be scarcely 
perceptible. On the next day he voided a great quantity of 
blood from his intestines ; and on the day after he died, 
falling a victim to internal bleeding, from the return of the 
divided vessels with the prolapsed intestine." — (Cooper's 
Lectures. By Tyrrell, p. 801. Philadelphia, 1839). Sir Ben- 
jamin Brodie also repudiates the operation by excision, 
having nearly lost three or four patients from hemorrhage 
caused by it. — (Brodie, Libri eitati, p. 314). Mr. Syme, of 
Edinburg, Scotland, also condemns the operation as exceed- 
ingly dangerous on account of serious or fatal hemorrhage. 
u The blood," says he, " does not readily escape externally, 
but accumulating in the rectum, excites the desire to go to 
stool, and is then voided in the form of a dark-colored fecu- 
lent-looking fluid, which may impose upon the attendants, 
and conceal from them the true situation of the patient." 
He further remarks, " If other practitioners besides Sir A. 
Cooper had been equally candid in relating their fatal cases, 



HEMORRHOIDS — PILES. 83 

we should doubtless have had more testimony as to the dan- 
ger of this operation ; and every surgeon who has practiced 
it must have experienced more or less alarm." — {On Diseases 
of the Rectum, p. 77. Edinburgh, 1854). The celebrated 
French surgeon, Baron Dupuytren, during his life time, 
invariably removed hemorrhoidal tumors with the scissors ; 
but such was his constant dread of fatal haemorrhage, that 
he never neglected the precaution of either immediately 
applying the heated iron to the parts, or leaving an assistant 
with the patient, in order to arrest the bleeding at once, by 
the same means, should it occur. Indeed, this surgeon recom- 
mended the actual cautery to be applied to the parts, in 
every case, immediately after each operation of the kind, as 
he found its application absolutely necessary in nearly every 
patient upon whom he operated, in order to arrest fearful 
hemorrhage ; and for this purpose had special instruments 
constructed — cauthre en haricot; cauthre en roseau. — {Lecons 
ovales de Clinique Chirurgicale, tome 1, p. 357). 

Dupuytren's method, however, of excising internal piles 
with the scissors, and then applying the heated iron to the 
cut surfaces, is a most cruel, a most barbarous proceeding, 
and one that should never be adopted. The late and 
lamented Dr. Bushe, of New York, has also recorded his 
decided reprobation of this operation. This talented author 
died in the midst of his labors, and much too soon for the 
cause in which he was so ardently engaged, and of which he 
bade so fair to be one of its brightest ornaments. Dr. Bushe 
says, " That excision is not likely to be attended with danger 
from haemorrhage, I deny ; for I performed the operation 
several times, and after it, have had to tie up arteries, plug 
the rectum, and in one instance, to apply the actual cautery. 
Indeed, I so nearly lost two patients, that when left to my 
own choice, I no longer have recourse to this operation. In 
the cases I have operated on, the haemorrhage has never 



84 HEMORRHOIDS— PILES. 

been alarming during the operation, but in one instance; 
and in it, I was compelled to make firm pressure with the 
two first fingers of my left hand, for a considerable length of 
time ; a procedure which appeared necessary to prevent a 
most frightful haemorrhage. Generally, however, after these 
operations, the haemorrhage does not occur for a few hours ; 
then the patient, who may have been perfectly comfortable, 
becomes anxious, restless, and is seized with rigors, spasms of 
the extremities, cold perspiration, sickness of the stomach, 
swelling and tension of the abdomen, particularly in the left 
iliac fossa, and colic pains. His pulse becomes small, fre- 
quent and irregular ; his respiration anxious, his countenance 
pale ; he is vertigous, and faints. All this time, the blood is 
accumulating in the colon, and he may die, without dis- 
charging it ; but frequently, the tenemus is so great, that he 
goes to stool, evacuates large clots of blood, faints, and some- 
times dies. More commonly, however, the discharge of it 
takes place in the recumbent position, and brings relief ; but 
after some time, the haemorrhage returns, and in this way 
some patients have died." (On Diseases of the Rectum,]). 
183. New York, 1837.) 

With regard to the actual cautery (heated iron) as a 
remedy for the destruction of hsemorrhoidal tumors, as prac- 
tised by some French surgeons at the present day, I would 
only remark that it is a most savage operation, and should 
not be countenanced. Very few sane persons, I should think, 
would ever submit to it ; except those in hospitals, who can- 
not help themselves. 

The potential cautery is also considerably used at the pre- 
sent day for the removal of piles, especially in the form of 
caustic potash and the mineral acids. A few years ago, Dr. 
Houston, an able physician of Dublin, introduced as some- 
thing new the nitric acid as a remedy for destroying haemor- 
rhoids ; since then it has been introduced into this country, 



HAEMORRHOIDS — PILES. 85 

together with some of the other mineral acids for the same 
purpose. Instead, however, of the mineral acids being a 
new remedy for removing piles, they were used for this very 
purpose upwards of two hundred years ago, by the celebrated 
Riverius, whose work is now before me. He recommends 
the piles to be burned off by the " Oyl of Vitriol" (sulphuric 
acid) and in extreme cases, by the Aquafortis (nitric acid.) 
( The Pr actio of Physic, c&c. By Lazarus Biverius. Boole 
X., Chap. X,jp. 315. Montpellier, 1653.) 

I have here introduced excision, both by the knife and the 
scissors, as well as cauterization, both by the actual and the 
potential cautery, for the purpose merely of condemning 
them, as cruel, extremely dangerous, and, therefore, unscien- 
tific measures, in the treatment of this disease ; and had I 
time and space I could here introduce numerous instances, 
even in our own country, and in our very midst, of the dan- 
gerous, as well as fatal effects of these measures, even when 
in the hands of some of our most eminent surgeons. "Who 
has not seen or heard of such cases % 

I now declare, and I challenge contradiction, that neither 
of the surgical measures above named, nor any others of a 
painful or dangerous character, are now necessary to the 
radical cure of this disease. 

Spontaneous Cure of Piles. 

Sometimes, pile tumors of the permanent kind, whether 
internal or external, are spontaneously cured. This natural 
cure is brought about in external piles, by inflammation, 
consolidation, and subsequent absorption of the lymph. In 
internal piles, it is brought about by strangulation and morti- 
fication. The tumor or tumors are prolapsed, and cannot be 
returned, owing to the resistance of the sphincter muscle 
which encircles them firmly, like a ligature ; thus completely 
strangling them, and cutting off their circulation. Mortifica- 



86 HEMORRHOIDS — PILES. 

tion soon takes place, sloughing follows, and the tumors are 
destroyed. Sir Benjamin Brodie, in one of his lectures, 
gives a case in point. " The late Dr. Pearson, who was for 
a very long period of time, physician to this hospital, was 
the physician and friend of the celebrated Mr. Home Tooke.- 
Many- years ago, I was dining with Dr. Pearson, and after 
dinner he gave an account of Home Tooke's illness. He 
said that he had long labored under piles ; that at last morti- 
fication had taken place ; that there was no chance of his 
recovery ; and he added, that he had that morning seen him 
for the last time. I remember that in the middle of this his- 
tory, there came a knock at the door, on which Dr. P. said, 
1 Here is a messenger with an account of my poor friend's 
death.' However, it was some other messenger ; but by-and- 
by, a messenger did arrive, saying that Home Tooke was 
much the same, or a little better. It turned out, as I have 
been informed, that the piles sloughed off, and from that 
time, he never had any bad symptoms. In fact, if I have 
been correctly informed, he was cured of a disease which had 
been the misery of his life for many years preceding, and he 
lived for some years afterwards." (Libri citati,p. 311.) 

This natural cure of hemorrhoids, however, is an exceed- 
ingly painful process. The powerful contractions of the 
sphincter ani muscle upon the protruded tumors, in some 
instances, occasions the greatest agony. I have witnessed 
several cases of this kind, and have been compelled, from the 
intolerable suffering of the patient, to lay open the protruded 
and strangulated tumors with the abscess lancet, and scoop 
out their contents ; or to apply leeches and fomentations. I 
would, therefore, advise the patient never to wait for a spon- 
taneous cure in this manner, but to have his disease removed 
before, and thus avoid the pain and evils which generally 
attend it. 



HEMORRHOIDS — PILES. 87 

Concluding Remarks. 

I might have entered into a minute investigation of the 
pathology, the anatomy, &c, of hemorrhoids, by giving my 
own views, as well as the views and speculations of others ; 
but this would have been foreign to the object of this work ; 
and inasmuch, as it is not intended for the experienced medi- 
cal practitioner, I have excluded all novelty and ingenious 
speculation, and admitted nothing but admitted truths, of a 
useful kind. 

This chapter will be concluded by giving some extracts 
from letters (hundreds of which I have on file) from persons, 
who themselves labored under this disease, and who had been 
treated by the most eminent of the medical profession, and 
had also tried all the nostrums of the day. They will do 
more to enlighten the common reader, regarding the nature, 
the cause, the symptoms, and the consequences of piles, than 
any thing else. These letters speak a plain, familiar, and 
perfectly intelligible language to all ; no medical knowledge, 
no peculiar strength of intellect, nothing, in short, but plain 
common sense, will be requisite for their complete appre- 
ciation. 

Letters from Persons Afflicted with Piles. 

LETTER I. 

M A , Nov. 1, 1841. 

Dear Doctor : — I have lately learned that you have been quite suc- 
cessful in the treatment of diseases of the rectum, &c. I am now laboring 
under one of those diseases, piles, in their most aggravated form. I have 
suffered with this painful and distressing disease, for about two years • and 
although I have obtained occasionally, partial relief, from my physicians, 
and from the use of Hay's Liniment, and several other remedies j yet still 
the cause of the disease has not been touched, and I am now suffering the 
greatest pain. I am forty-five years of age ; habits sedentary ; by profes- 
sion a judge ; general health quite delicate, and bowels always constipated. 
I am certain that my piles were caused by my being compelled constantly 
to use harsh medicines to relieve my costiveness. When I go to stool I 
suffer the most acute pain ; and I defer it as long as I possibly can, on this 



88 



HEMORRHOIDS — PILES. 



account. When stooling, a large portion of the bowel comes down, together 
with four or five large tumors ; sometimes they bleed very much, which 
relieves me. They never return of themselves; but I have to return them 
with my fingers, which is always a truly painful operation. I lately con- 
sulted an eminent physician, who at once said he could cure me by aloes. 
He gave me a preparation composed of nearly all aloes. I tried it 
about four days, and was rendered very much worse by it ; indeed, 
it completely disqualified me for any business. I have been so little 
benefited, that I had lost all confidence in physicians ; but hearing you so 
favorably spoken of, I have concluded to make one more effort to be cured. 
I have lately discovered a small ulcer on the bowel when it protrudes, it 
is about an inch up the bowel. I am fearful that either ulceration or fistula 
is about to take place. The object of this communication, is to learn from 
you, whether you think you can relieve me, and if so, I will visit you as 

soon as I get through holding my court at , at which place I wish 

you to address me immediately. 1 am respectfully, yours, &c. 

The above letter was from Mr. L , a judge of the 

Supreme Court of A . I subsequently removed four 

hemorrhoidal tumors for this patient, and thus entirely re- 
lieved him. 



LETTER II. 

A Ga.. July 3, 1843. 

From a boy I was subject to a prolapsus of the bowel, which was 

attended with but little pain, or inconvenience, as the protruded parts 
would always assume their natural position immediately after stooling, 
without any trouble. Within the last six years, however, several large 
tumors have made their appearance, and now, when the protrusion takes 
place, it is as big as the largest size orange. The least exertion causes the 
parts to come down, which causes the most severe pain and spasm of the 
muscle at the end of the bowel. The parts are covered frequently with 
mucus, streaked with blood ; and sometimes there is quite a quantity of 
mucus discharged, which has the appearance of red currant jelly. I am 
usually confined to my bed for three or four hours after stooling, owing to 
the parts remaining out, and my inability to return them, and to the con- 
tinued action of the muscle, and the feeling as if something was stuck in 
the bowel. At such times there is a great fullness of the head, and a 
numbness of the extremities, with pain and weakness of the back, and 
great derangement of the urinary organs ; so much so that I have often to 
use the instrument to draw off the urine. From my continued and accu- 
mulated sufferings, my general health is daily growing worse ; my nervous 



HEMORRHOIDS— PILES. 89 

system is completely racked, and I have become quite irritable, and the 
slightest excitement, either mental or corporeal, will bring on a paroxysm 
of my disease. To avoid the suffering, I have an evacuation from my 
bowels only every alternate day. I had two external tumors cut off with 
the knife, without the least benefit whatever. I am a lawyer by profession, 
and am thirty-eight years of age. This is a general outline of my disease. 
I have employed various physicians, and all the quack preparations of the 
day, to no purpose. 

The writer of the preceding letter never visited me, and 
consequently I am unable to report the result of his case. 
From his description, it was doubtless piles, complicated 
with a prolapsus of the rectum, and perhaps fissure of the 

anus. 

LETTER III. 

H , Ohio, June 6, 1846. 

1 have been troubled with piles for a number of years, but not 

badly, until within the last two years. I have been informed that you can 
cure me, and if you think you can do so, after hearing my statement, I 
will come to Louisville. They are what is termed blind piles. There are 
three or four lumps, (one as large as a hen's egg) which get much larger at 
times, and pain me very much. When I evacuate my bowels, the tumors 
come out, and have the appearance of a large rose, or ripe tomato. My 
bowels are always confined, and I have constantly to resort to purgative 
medicines 

I treated the author of the above letter, at Louisville, Ky., 
in the fall of 1847. Three large pile tumors were removed ; 
and he still remains entirely relieved, now seven years, 1854. 

LETTER IV. 

P P C , La., Aug. 5, 1846. 

Dear Doctor — By mere accident, as it were, I learned that you were 
celebrated for curing diseases of the lower bowel, and being afflicted with, 
as I conceive, such a disease, I take the liberty to address you. My disease 
is a discharge of blood at every time I stool, without giving me the least 
pain. Indeed, up to this day, and it has been of some eight or ten years 
standing, I have never suffered, consciously, a single moment from it, and 
were it not that it may run to some other disease, more serious in its char- 
acter, I would not trouble you nor myself about it. But I am now forty- 
two years old, and am aware that the decline of life is not the time to 



90 HEMORRHOIDS— PILES. 

u heal old sores.'' I have consulted many physicians ; but they make light 
of it. and put me off by saying it is only the piles. The discharge of blood 
is always after the evacuations from the bowels, and distinct, having no 
mixture with it, and amounts to from one to two gills daily. 

In the spring of 1847, the writer of the above letter visited 
me at New Orleans, and submitted to treatment. I ascer- 
tained that the haemorrhage proceeded from two open-mouthed 
pile tumors, not larger than small peas. I removed them, 
and the bleeding stopped, and never returned. 

LETTER V. 

B , Ky., July 9, 1845. 

I suffered but little from my piles until the spring of 1841, when four or 
five tumors projected, and became hard, and almost as black as if mortified, 
attended with the most excruciating pain. No applications which my phy- 
sicians could make, could give me relief. Lately these tumors have got 
worse, and when I am stooling, there is quite a stream of blood running all 
the time, so that I have to hurry and return them as soon as possible \ for 
some time after, there is a burning and throbbing of the parts, as if a red 
hot iron was there, which often forces tears from my eyes. I dare not walk 
about ; my bowel falls down in a few minutes if I am on my feet, and I am 
so weak that I am scarcely able to stand. I have heard that you have cured 
many desperate cases of piles. I am confident I can get no relief from phy- 
sicians here; for I have tried them all to my sorrow. Can you not cure 
me ? I do dread the effects of this painful disease, and am anxious to be 
cured immediately. 

I treated the above case successfully, at Louisville, Ky., in 
September, 1845. The patient, to the best of my knowledge, 
still continues well, now, 1854. 

LETTER VI. 

F , A . Oct. 30, 1843. 

I write at the request of Mr. , who has been afflicted with piles 

for seven or eight years, and has been getting gradually worse for the last 
four years. He has submitted already to two operations of the knife, by 

Doctor , of , without any beneficial result. He is gradually 

getting worse, and unless he is cured very shortly, death will relieve him 
of his sufferings. One of his symptoms is profuse bleeding when he stools, 
which has reduced him very much, and makes him look as pale as death. 



HEMORRHOIDS — PILES. 91 

He is now confined to his bed, suffering nearly all the time, and has never 
been the least benefited by the operations, or any thing else that has been 

done for him. He has seen Mr. C , whom you cured two years ago, 

and who advised him by ali means to make immediate application to you . 
He is now not able to visit Louisville. Can you not visit him ? 

Being unable to visit the patient alluded to in the above 
letter, at the time ; and not having heard any thing of him 
since, I am unable to say how his case terminated. 

LETTER VII, 

C , Mo., Aug. 24, 1841. 

My wife has, for several years, been grievously afflicted with piles. 
There is often copious discharges of blood, with considerable inflammation 
and much pain of the parts affected. She has great weakness, and consid- 
erable pain in the back, head ache, and in fact, the whole nervous system 
is highly affected. I have tried all the physicians here of eminence ; but 
she has not been cured, and is gradually getting worse. My fear is, that 
her piles will terminate in fistula. 

I was highly fortunate in treating successfully, the case 
above alluded to, without seeing the patient. 

LETTER VIII. 

C L , April 20, 1841. 

Dear Sir — My wife, having labored under that unpleasant and untrac- 
table disease called piles, for the last three years ; having in the mean 
time tried all the nostrums vended for its cure, besides trying the prescrip- 
tions and the advice of all the medical men of this vicinity, without the 
least benefit, I have determined to make another effort to obtain relief for 
her, by applying to you. It may be proper for me to state, that there is 
but a slight protrusion of the parts, and these only whilst at stool. They 
are easily pushed back, and frequently return of themselves. She has often 
pains and numbness of the lower extremities, which she attributes to this 
disease. The tumors most always bleed when she has an evacuation from 
the bowels, and the amount of blood lost is considerable, and seems to 
increase ; and at this time makes her appear very pale indeed, and effects 
her head, producing as she terms it, " strange and wild feelings of the 
head." 

The patient referred to in the above communication, is the 
wife of a highly respectable physician of the state of Louis- 



92 HAEMORRHOIDS— PILES. 

iana. In May 1845, and four years after the date of the 
doctor's letter, she visited me at Louisville, Ky. She then 
had, in addition to her hsemorrhoidal disease, a complete 
fistula in ano. I met with complete success in the treatment 
of her case, and she continues entirely free from both dis- 
eases to the present time, now, 1854. 

LETTER IX. t 

B , Md., Sept. 21, 1843. 

Dr. Bodenhamer : Dear Sir — A clergyman, Mr. , from your state, 

has informed my aunt that you cured him of a desperate disease, the piles, 
which he had long labored under. She requests me to write you, and 
inform you, that she has been subject to the most painful attacks of piles 
for the last six years. She is thirty-five years old, and has been a widow 
five years. Her health in other respects, is tolerably good ; but when her 
bowels become either too loose or too costive, she will have a sudden 
attack. The piles swell up suddenly, as large as a hen's egg ; she has two 
or three of them. They are then so painful that she cannot bear to have 
them touched ; they frequently bleed, and most always protrude. When 
the attack comes on, she is confined to bed, and suffers the most excruciat- 
ing pain. Nothing yet has done her any good, and she has consulted all 
the best doctors in this city. These spells sometimes last four or five days, 
and then the piles go away entirely, and she is completely relieved, and 
between the spells she is as well as usual. 

I treated the patient alluded to in the above letter, without 
seeing her, with but partial success, however. Had she 
visited me, she doubtless would have been perfectly cured. 

LETTER X. 

N- , Ind.j July 28, 1840. 

Dr. Bodenhamer : Dear Sir — I have been afflicted for the last ten years 
with haemorrhoids to such a degree, that I am unable to be on my feet but 
a small portion of the time. When I stand on my feet, or walk any dis- 
tance, and at every evacuation of my bowels, there is a protrusion some- 
thing similar to a large rose, made by the formation of five or six lumps 
near the extremity of the bowel. These I have always to press back into 
the rectum, by pressing gently on each side of them with my fingers, and 
it is with much difficulty that 1 can keep them from protruding even when 
sitting or lying down. I cannot pass urine unless the tumors are down. 
When they are inflamed and swelled, they are awfully painful, the pain 



HEMORRHOIDS — PILES. 93 

extending down my legs to my feet, with cramps in my feet and toes. I 
have paid hundreds of dollars to physicians and to quacks, and for various 
nostrums, all to no purpose. I have even been foolish enough to carry 
buck-eyes in my pocket for my disease ! This last remedy, I believe, has 
done me just about as much good as any of the rest ! ! 

The author of the above letter, was successfully treated at 
Paris, Ky., during the winter of 1841. 

LETTER XI. 

P e, Ky., April 3, 1840. 

Dear Doctor— I have just seen Mrs. T , whom you cured some 

time since of piles. She says that her case was as bad as mine, as I am 
also laboring under this disease. Mine are the blind piles, and I have had 
them for three years, and for the last thirteen months, confined to my room. 
I have been the patient of four doctors, and have found no relief. From 
what Mrs. T. says, I am fearful that I am about to have fistula, which I 
awfully dread. She says that your treatment was so mild, that you did 
not hurt her at all. My age is forty-two years, and I have been the mother 
of four children. If I was cured of this wretched disease, I would be 
entirely well I believe in other respects. I hope you will write me an 
encouraging letter. 

I advised the writer of the above letter to visit me and 
have her piles at once removed ; but from time to time she 
found it inconvenient to do so, and I finally lost sight of 
the case. 



LETTER XII 



Ky., June 16th, 1842. 



Dear Doctor — This will be handed you by my friend, Mrs. H., who 
visits you for the purpose of obtaining your skill in the treatment of her 
case, which is piles, and similar to what mine were. She has been the 
victim of the regular, as well as irregular practice of the day in this dis- 
ease. I gave her every encouragement to call on you, knowing that you 
could cure her. As regards my own case, I am entirely well, and have 
been ever since I left you, two years ago. Indeed, my general health is 
now better than it has been for twenty years. I have not taken one single 
drop of purgative medicine since I left. This you will think strange, as I 
was always taking two or three large doses of pills every week, to keep my 
bowels open. Whenever I find that my bowels are becoming costive, I 
use the means you directed occasionally, and they relieve me. I would 



94 HEMORRHOIDS — PILES. 

not exchange this simple and excellent remedy, for all the drugs in our 
country, in such cases. I have recommended it in many cases of piles, as 
a palliative, with the most happy results. All who have tried it, say that 
it has relieved them more than all the applications they have ever tried. 
I could never have forgotten you, had you never done any thing else than 
relieve me entirely of my obstinate constipation, 

I am, very respectfully, your friend. 

LETTER till-. 

, Mi— , December 1, 1844. 

Dear Doctor — I am happy to inform you that my wife has not had the 
slightest return of piles since she left you, last spring. Her general health 
has improved so much that you would scarcely know her ; and what is 
best of all, her bowels keep entirely regular, without her resorting to medi- 
cine. She still follows your directions with regard to purgative medi- 
cines, to diet, &c. In fact, her general health is better than it has been 
for ten years ; for during that time, scarcely a day passed without her 
taking more or less medicine. 

The following extract of a letter is from my friend, T. J. 
Casey, Esq., of New Orleans, whom I radically cured of 
piles in the winter of 1851. I am truly happy to have it in my 
power to say that my kind friend remains entirely free from 
the disease to the present time, 1855. 

LETTER XIV. 

New Orleans, March 25, 1851. 

Dear Doctor :— 1 cannot close this note without thanking you most 

cordially for the kindness and the skill displayed towards me, during your 
treatment of that most painful and disagreeable of all diseases — the piles. 
I am entirely cured of my old disease, and feel better than I have done for 
twenty-five years. If any thing I could do, say or write, would add one 
mite to your already wide-spread reputation, I would, I assure you, most 
cheerfully do it. 

Believe me ever your most grateful friend, 

T. J. Casey. 

The following letter is from my kind friend, the Kev. Ben- 
jamin Chase, of Natchez, Miss., whom I cured at New 
Orleans, in the winter of 1854, of piles, complicated with a 
prolapsus of the rectum. His ease was one among the most 
aggravated I had ever seen. 



H^MOERHOIDS — PILES. 95 

LETTER XV. 

Natchez, April 11. 1855. 
Dr. W. Bodenhamer, — Dear Sir : — I am happy to have the privilege 
of introducing to your acquaintance my brother-in-law, Mr. A. C. Hender- 
son, of this place. He visits New Orleans, in part, to ascertain whether 
there is any way of obtaining relief from the unpleasant effects of a former 
hernia. I do not know whether that is one of the maladies to which you 
have given special attention or not. But be that as it may, I am glad of 
the opportunity of his seeing you. 

It is very gratifying to me, to be able to say I am entirely relieved of all 
inconvenience from my past sufferings, and I shall ever feel grateful to you 
for your invaluable services, in procuring that relief. With sentiments of 
esteem and respect, I remain, 

Very sincerely yours, 

Benjamin Chase. 

My friend, the Rev. Mr. Rampon, of Pensacola, Fa., the 
writer of the following extract, visited me at New York, on 
the 4th of August last, in a most deplorable condition. He 
was losing about half a pint of blood at each evacuation of 
his bowels, the hemorrhage proceeding from three large 
piles. His flesh and strength were gone ; his countenance 
and lips were pallid ; pulse feeble and quick ; skin dry and 
hot ; and h.e complained of shortness of breath and violent 
palpitation of the heart, induced by the slightest exertion, 
especially when ascending steps. The tumors were removed 
and the bleeding at once ceased ; his flesh, strength and color 
speedily returned, and he left for home on the 11th of Octo- 
ber, 1854, a new man. 

LETTER XVI. 

Pensacola, Fa., April 25, 1855. 

My Dear Doctor : It is now eight months since I was under 

your care, and so far, there is not the least sign of bleeding, or of a return 
of my old disease, the piles ; and I have taken no medicine whatever. My 
general health is perfect ; indeed, I am quite a resuscitated man, feeling, 
at least, twenty years younger. My congregation, on my return last fall, 
could scarcely believe that I was the same and identical person. When I 
left them to visit you at New York, they gave me up as lost ; but when I 
returned, it was a public rejoicing, and had you been present, you would 



96 HEMORRHOIDS — PILES. 

have received an ovation for the benefit conferred upon their pastor. I sin- 
cerely wish the whole world knew you, and your method of treating those 
diseases. 

Please let me know when you leave New Orleans for New York. I hope 
you are well, and I pray Almighty God to preserve your precious life for 
the benefit of so many afflicted persons whom you daily relieve and cure. 
With a most grateful heart, I remain your friend, 

C. Rampon. 

In the winter of 1853, I cured the Eey. H. M. Mc Tyeire, 
editor of the " New Orleans Christian Advocate" of piles 
in a most aggravated form. My friend, I am happy to say, 
remains well to the present time, 1855. In his paper of Sep- 
tember 23, 1854, he makes the following remarks: 

W. Bodenhamer, M. D. — By reference to the card of Dr. Bodenhamer, 
it will be seen that he has adopted New York as his summer quarters, and 
New Orleans as his winter. The afflicted in the South are highly favored 
by this arrangement. Dr. B. belongs to the old school, both as a gentle- 
man and practitioner. His remarkable success in one direction of his pro- 
fession determined his practice to it. He is no quack, no one idea man. 
He has the modesty of true science — too modest to make known the sin- 
gular success of his treatment, and for years even to publish a card. We 
have yet to hear of a case in which he has failed. Our own experience 
and knowledge prompt us to this notice. 

The following are the names of a few more persons whom 
I have radically cnred of piles ; some of them were treated 
a number of years ago, : 

Edmond Bryant, aged 52 years, farmer, Shawnee Kun, 
Ky. ; cured in the spring of 1841. 

James Cage, Esq., aged 73 years, sugar planter, Houma, 
La. ; cured in the summer of 1845. 

J. M. Trimble, Esq., aged 40 years, farmer, Hillsboro', 
Ohio ; cured in the fall of 1847. 

Captain William Porter, aged 50 years, New Orleans ; 
cured in the spring of 1848. 

Cornelius Mc Coy, Esq., aged 48 years, Portsmouth, Ohio ; 
cured in the summer of 1850. 



FISTULA IN ANO. 97 

Clark Williams, Esq., aged 45 years, Cincinnati, Ohio ; 
cured in the fall of 1850. 

James H. Walker, Esq., aged 34 years, cotton planter, 
Eldorado, Arkansas ; cured in the winter of 1851. 

Henry Pace, Esq., aged 42 years, Cincinnati, Ohio ; cured 
in the fall of 1853. 

Wilson Johnson, aged 26 years, farmer, near Circleville, 
Ohio ; cured in the fall of 1853. 

General Persifer F. Smith, of the U. S. Army, Corpus 
Christi, Texas ; cured in the winter of 1853. 

Thomas M. Foster, aged 38 years, Indianola, Texas ; cured 
in the winter of 1853. 

Rev. J. Hoge, D. D., aged 69 years, Columbus, Ohio ; 
cured in the spring of 1853. 



CHAPTER VH. 

FISTULA IN ANO. 



This disease, like hsemorrhoids, is of very ancient date. 
The first distinct and comprehensive description of its nature 
and treatment is given by Hippocrates, the father of medi- 
cide, in his Liber de Fistulis. It is also treated of by Ce'lsus, 
in his De Medicina, and by Galen, in his Methodus Medendi. 
From these early times to the present, medical literature has 
been very prolific, in furnishing us with a countless number 
of monographs on its nature and treatment. These records 
contain the most indubitable evidence, that it is a disease 
very difficult to treat successfully, under the most favorable 
circumstances, and that its treatment heretofore, has been 
inefficient. 

In 1422, Henry Y., King of England, died of this disease, 
being in the thirty-fourth year of his age and tenth of his 



98 FISTULA IN ANO. 

reign. The great historian Hume, in relating this event, 
says, "But the glory of Henry V., when it had nearly 
reached the summit, was stopped short by the hand of 
nature ; and all his mighty projects vanished into smoke. He 
was seized with a fistula, a malady which the surgeons at 
that time had not skill enough to cure ; and he was at last 
sensible that his distemper was mortal, and that his end was 
approaching. He sent for his brother, the duke of Bedford, 
the earl of Warwick, and a few noblemen more, whom he 
had honored with his friendship ; and he delivered to them 
in great tranquillity his last will with regard to the govern- 
ment of his kingdom and family," &c. [History of England, 
Vol. II, p. 368. Boston, 1851.) 

Shakspeare rendered this disease quite notorious by making 
it a very important and leading circumstance in his play — 
" AlFs well that ends well," which is said to have been writ- 
ten in 1606. 

The celebrated Astruc, in his Latin Thesis on fistula of the 
anus, relates an interesting incident relative to this disease. 
He says that for an age previous to 1686, the fistula of the 
anus had almost sunk into oblivion, and was scarcely ever 
seen or heard of by physicians ; not that the disease did 
not exist ; but in consequence of a false delicacy in those 
who had it, in not making it known; despairing of any 
remedy, they preferred to conceal a disease which at that 
time was considered incurable. No sooner, however, was it 
known that so great a personage as Louis XIY. had this dis- 
ease, than it at once became fashionable, and a vast number 
of cases suddenly appeared, and after the King's example, 
every one made an open confession of this his once secret 
malady. 

Dionis, in his surgical work, also alludes to the same cir- 
cumstance. " This disease, at present," says Dionis, " seems 
more frequent than formerly ; we every day hear of opera- 



FISTULA IN ANO. 99 

tions performed on such persons as did not before seem 
afflicted with it. It is a disease grown into fashion, since 
that which the King had, and on which the surgeons were 
forced to perform the operation, in order to its cure. Seve- 
ral of those who before that time carefully concealed their 
having it, are now not ashamed to publish it, and some cour- 
tiers have even chosen Versailles, for the place where they 
will undergo this operation, because the King would there be 
informed of all the circumstances of their indisposition. I 
have seen above thirty who desired to have the operation 
performed, and whose folly was so great, that they seemed 
angry when they were assured that they did not at all need 
it." (Cours l? operations De Chirurgie, <&c. Huitieme Edi- 
tion. Tome Z, p. 406. Paris,1782.) 

There is a case parallel to this related by Pliny. " In the 
reign of Tiberius Caesar," says he, " the colic first showed 
itself, nor did one man in Rome ever complain of this disease 
till the Emperor had been severely attacked with it." {Sis- 
tor Natur, Lib. XXV., Cap. I.) 

James Syme, M. D. } of Edinburg, in the first edition of his 
work on the diseases of the rectum, says that, " Louis XIV. 
suffered from fistula in ano, and being natv/rall/y* unwilling 
to undergo the operation which his medical attendants as- 
sured him was necessary, listened to various proposals for 
curing the disease without having recourse to the knife. In- . 
stead of trying these methods on his own person, however, 
he collected a great number of his subjects, who labored 
under the same infirmity, and caused the proposed experi- 
ments to be tried on them. Some of them he dispatched to 
the waters of Bareges, others to those of Bourbon, and many 
more he shut up in rooms, provided with every thing that 

* It was not at all surprising, one would think, that the Grand Monarque should 
have been naturally unwilling to submit to such an operation. I should like to 
see the first patient, even in these days of chloroform, who would be naturally 
willing to have his rectum split open. 



100 * FISTULA IN ANO. 

could be suggested for the purpose in view. At the end of a 
year, finding that not a single patient 7 had been cured, his 
Majesty yielded to necessity, and permitted his surgeon, M. 
Felix, to perform all the incisions which he judged proper. 
We have here a striking illustration of the necessity of the 
operation,* and the importance, attributed to its performance 
as formerly practiced, may be estimated from the number of 
medical men, who were present on this occasion, together 
with the amount of their remuneration." 

As the history of this case is interesting in several respects, 
I will, for the benefit of the reader, give it entire from the 
celebrated surgical work of Monsieur Dionis. " In the year 
1686," says Dionis, " there arose, near the king's anus, a 
small tumor inclining towards the perinseum ; it was neither 
inflamed nor very painful ; it grew slowly, and after ripen- 
ing, broke of itself, by reason that the king would not suffer 
Monsieur Felix, his principal chirurgeon, to open it as he 
proposed. This small abscess was attended with the ordinary 
consequences of those not sufficiently opened to admit the 
application of remedies to the bottom of the cavity ; there 
was only a small orifice through which the matter run ; it 
continued to suppurate, and at last became fistulous. 

" The sole way left of curing it was by manual operation ; 
but the Great cannot always be brought to yield to it. A 

* It is strange that intelligent surgeons of the present day should refer to the 
case of Louis XIV., to prove the positive necessity now of the knife operation in 
the cure of this disease. The King never submitted to any other treatment except 
the knife ; and to say the least of it, his case was a very slight one, being, as 
Dionis declares, quite small and superficial. Is this trivial case, then, which was 
treated some two hundred and sixty-eight years ago, to be the standing test of the 
superiority, the success, and the necessity of the knife operation, now and for all 
time to come ! The idea is absurd. I can tell Dr. Syme, howe-wer, what this 
case really does illustrate. It illustrates the, ignorance of all the parties concerned, 
respecting the true nature and treatment of the disease ; and it also illustrates, 
most forcibly, " the great pomp and circumstance " of an operation, even although 
quite trivial ; just such a ridiculous parade as too often takes place in our own 
day, and of which Dr. Syme must be quite familiar. 



FISTULA IN ANO. 101 

thousand persons proposed remedies, which they pretended 
to be infallible, and some of them, which were concluded to 
be the best, were tried, but none of them succeeded. 

" His Majesty was told that the waters of Barege were excel- 
lent in these cases, and it was also reported that he would go 
to the waters ; but before taking the journey, he thought fit 
to try them on several patients ; four persons were found who 
were afflicted with the same disease, and sent to Barege 
at the king's expense, under the direction of Monsieur Ger- 
vais, chirurgeon in ordinary to his majesty ; he made the 
necessary injections of this water into their fistulas for a 
considerable time, and used the proper means for their 
cure, and at last brought them all back, as, far advanced 
towards that end, as when they first went thither. 
• "A woman reported at court that, going to the waters 
of Bourbon, in order to be cured of a particular distemper, 
she was by the use of them cured of a fistula, which she 
had before she went thither. One of the king's chirurgeons 
was sent to Bourbon with four other patients, who returned 
in the same condition they went. 

a A Jacobin friar, applying to Monsieur Louvoy, told him 
that he had a water with which he cured all fistulas ; ano- 
ther boasted of a never-failing ointment, and yet others 
proposed different remedies, alleging the cures which they 
pretended to have done. That minister, determining to 
neglect no means in order to the procuring a restoration 
of a health so important as that of the king, caused several 
chambers to be furnished, in which he placed persons 
afflicted with fistulas, and caused them to be treated pur- 
suant to the several methods of the boasting pretenders to 
cure them in the presence of Monsieur Felix. 

" A year was spent in these various essays, and not one 
patient cured. 

" Monsieur Bessiere, who examined the indisposition, be- 



102 FISTULA m ANO. 

ing asked his thoughts by the king, freely answered his 
majesty, that all the remedies in the world would prove vain 
without manual operation. 4 

"At last the king, to whom Monsieur Louvoy, and Mon- 
sieur Felix gave an account of what had passed, seeing no 
hopes of being cured otherwise than by operation, on which 
Monsieur Felix continually insisted, determined for it ; he 
delayed it till his return from Fontainbleau, and one morn- 
ing had it performed when nothing of the nature was sus- 
pected by the courtiers, who, going to attend the king's levee, 
were informed that he had undergone the operation, and 
resolutely suffered all the incisions which Monsieur Felix 
thought proper to be performed. 

" This happened on the 21st of November, 1687. Monsieur 
Felix, to whom the king had left the liberty of appointing 
what chirurgeon he pleased to assist him, chose Monsieur 
Bessiere, who was accordingly present at this operation ; 
where besides were only Monsieur Louvoy, and the two 
physicians, Dr. Daquin and Dr. Fagon. The cicatrizing was 
well managed, and the king perfectly cured. His majesty 
royally recompensed all those who had rendered him service 
whilst under this indisposition ; he gave to Monsieur Felix 
fifty thousand crowns ; Monsieur Daquin one hundred thou- 
sand livres ; Monsieur Fagon twenty-four thousand livres ; 
Monsieur Bessiere forty thousand livres ; and to each of his 
apothecaries, in number four — twelve thousand livres ; and 
to one Baye, Monsieur Felix's apprentice, four hundred pis- 
toles."* — (Libri citati^p. 419.) 

* Monsieur Felix received 50,000 crowns ----- $30,000 

Dr. Daquin " 100,000 livres - 20,000 

Dr. Fagon " 24,000 " 5,000 

Monsieur Bessiere " 40,000 " - 7,500 

Four Apothecaries (each 12,000 " $2,500) - - - 10,000 

Mons. Kaye (Apprentice to Mons. Felix) 400 pistoles - 1,000 

Total amount of fees, - $73,500 



FISTULA IN ANO. 103 

" These were," -says a writer in the Medico-Chirurgical 
Review, " royal days for surgeons. The fee which the ope- 
rator on the Grand Monarque, Monsieur Felix, pocketed, 
was six thousand pounds. The name of this gentleman is 
emblematic of the palmy days of surgery, in which he had 
the luck of flourishing. If an operator now receives a thou- 
sand pounds for giving sight to one of our millionaires, he 
is thought a marvellously fortunate fellow." 

Description of Fistula in Ano. 

The term fistula, which signifies a pipe, and which in sur- 
gery denotes the tube or narrow conduit leading from an 
abscess or cavity, is frequently misapplied, or used in an 
indefinite or vague sense ; often giving a very inadequate 
idea of the nature of the disease. Instead of simply denoting 
a pipe-like sore, or the canal or medium of conveying a fluid 
or extraneous matter to the surface, the term is often 
applied by the old surgeons, as well as a majority of those of 
the present day, to simple abscesses, or all suppurating exca- 
vations, especially about the rectum or anus. This departure 
from its strict definition, is doubtless caused by the fact that 
an abscess most always precedes fistula, and that it is the 
initiative in the production of fistula. Abscess and fistula 
generally stand in the relation of cause and effect ; hence this 
complication is usually confounded, and the term fistula 
made to embrace too much. This distinction, however, is 
important and should not be lost sight of by the surgeon ; for 
the indications in the treatment of simple abscesses and fis- 
tulous passages, are essentially different. An abscess may 
exist without being fistulous; but it is "liable sooner or later 
to become so, and the following is the process : — After the 
pus in the first instance is evacuated, its parietes do not 
approximate, and its cavity is not spontaneously obliterated, 
but becomes lined with a pseudo-membrane, and establishes 



104: FISTULA IN ANO. 

in its parietes one or more canals -or tubes, which are also 
lined with the same membrane, and through which it dis- 
charges its secretions. An abscess may also become fistul- 
ous by its cavity gradually diminishing in size, until it 
becomes itself a simple tube or sinus. It is in this manner 
that in time a definite organization is finally established, con- 
stituting a fistula. The discharge from and through fistulous 
passages, may present characteristics of pus, gleet, sero- 
purulent, sanguineo-serous, or mucous matter ; but the dis- 
charge varies like the cause. Sometimes it is white and con- 
sistent, sometimes thin and flaky, sometimes pure, and again 
mixed with the product of some natural secretion, according 
to the location of the fistula, the general health of the patient, 
the length of time the affection has subsisted, &c. 

Fistula in ano, then may be the result of an abscess in the 
vicinity of the anus or rectum, which continues to secrete 
and to discharge matter through one or more sinuses or open- 
ings. These fistulous sinuses or passages, are generally 
single ; but they sometimes ramify at their extremities, 
usually communicating with each other, and converging to 
one internal aperture. Their direction is mostly tortuous — yet 
they are sometimes straight, and present numerous contractions 
and dilatations in their course. 

Fistulse have been divided into three classes: complete 
fistula ; external blind fistula, and internal blind, or occult 
fistula. The first signifies that the sinus communicates with 
the bowel, and opens externally, forming a continuous canal 
from the cutaneous surface up into the intestine ; the second 
denotes that the sinus opens only externally, and the third, 
that the sinus opens only into the bowel. These two last are 
also called incomplete fistulse. ( Vide Plate IV.) 

Some authors deny the existence of any other but com- 
plete fistulse ; but this is a great error, as I have demon- 



Vistula coiuplicated ivatli piles 




. Jo 1 








a. Piles . 

b . Tistulaus openm^i^i^xoTjeiLiit, 



FISTULA IN ANO. 105 

strated by minute desection, in numerous cases — some of long 
standing. 

With regard to the number and form of the external and 
internal orifices, they vary materially. Generally, there is 
but one external opening ; yet often, there are as many as 
three, four, and six, and I have seen in consumptive patients 
as many as ten and twelve. All these, however, usually 
communicate with each other, and converge to one internal 
aperture. There is but rarely more than one internal open- 
ing ; yet I have seen as many as two, and even three. They 
are usually round and callous. Sometimes, however, they 
are quite soft. The external openings are commonly round, 
and studded with exuberant granulations which sometimes 
very easily bleed when touched ; they may be regular with- 
out granulations — especially if the disease is recent. Owing 
to the action of the discharge in old cases, the parts sur- 
rounding these openings, generally become hard, callous, and 
project, forming, in many instances, quite large tumors or 
excrescences. The direction and situation of the sinuses vary. 
Sometimes they open at quite a distance from the outer cir- 
cumference of the anal opening, and extend obliquely 
upwards and inwards through the external sphincter and cellu- 
lar and adipose tissue, until they open into the bow T el. Some- 
times they pass through the fibres of the internal sphincter ; 
at other times they run between the sphincters, and then 
they ascend a little before perforating the mucous membrane. 
They are nearly always exceedingly tortuous in theia route, 
and sometimes most difficult to trace to their internal open- 
ing. They may frequently be felt externally and traced 
towards their origin. If the fistula be large and complete, it 
♦will be usually found at some distance from the anal open- 
ing ; but if it be small, it may be concealed beneath the folds 
of the fine skin, close to, or at this orifice. This kind of fis- 
tula is very apt to be overlooked, and great care is necessary 



106 



FISTULA IN ANO. 



in conducting the examination. I have seen many cases of 
this kind ; the patient having previously been often exam- 
ined without the disease being detected. If you ask him, he 
will perhaps tell you that his linen is daily soiled by a dis- 
charge which he attributes to piles ; but which is usually 
from such a fistula. 

The seat of the internal orifice, for the last ten or twelve 
years, has been the subject of considerable debate. M. 
Ribes, of Paris, contends that the internal orifice is almost 
invariably found very near the anus, and visible externally, 
on minute examination, andi'never more than five or six lines 
above the junction of the skin w T ith the mucous membrane. 
He gives the result of eighty observations to confirm this 
position. It was the opinion from the earliest times, and it 
still prevails to a considerable extent, that these sinuses usually 
penetrate the bowel high up. I will not enter into this con- 
troversy in the present work, but merely give the result of 
my own experience. In one hundred and sixty cases of 
complete fistula in ano, which I treated, I found that in fifty- 
nine cases, the internal orifice entered above the upper mar- 
gin of the internal sphincter muscle ; in thirty-four cases, it 
entered between the sphincters, and in the balance* sixty- 
seven, I found it to enter low down, so that it could be seen 
by everting the edges of the anus. These cases were exam- 
ined most minutely with especial reference to this point. 



Who are the Victims of Fistula in Ano f 

This disease is found among all classes in society, and in 
persons of very different constitutions : in some who are in 
excellent health, in other respects ; and in some, who are 
reduced by other diseases. It is generally met with in per-« 
sons advanced in life, and rarely in childhood. I have treated 
the disease in seven children, under four years of age. Per- 
sons of acute sensibility, who labor under fistula, usually suf- 



FISTULA IN ANO. 107 

fer great uneasiness about the part, especially when stooling, 
and they are often distressed by a feeling of weakness and 
imperfection which renders their existence almost intolera- 
ble. Others of less sensitive constitution, frequently give 
themselves no concern about their disease, and are able for 
a long time to bear up under its undermining influence. I 
have treated some five or six cases, in whom the disease had 
existed from fifteen to thirty years. 

Causes of Fistula in Ano. 

As this disease is preceded by anal abscess, it may originate 
from all those causes, whether local or constitutional, which 
produce that disease. They will be enumerated under their 
appropriate head, in the chapter on anal abscess ; yet it may 
not be improper to give some of the causes here. Perhaps 
the most frequent cause of fistula, is piles. Owing to the 
continued irritation which they produce, suppuration finally 
takes place at the base of some old pile tumor, which results 
in fistula, and in this way hundreds of cases are caused. 
Obstinate constipation, and the abuse of purgative medicine, 
the great sine qua non in relieving this condition, are both 
fruitful sources of the remote cause of this disease. The con- 
cussions occasioned by efforts in leaping, riding, <fcc., acting 
as they do, upon the whole amount of blood in the portal 
system which is unsupported by venous valves, produce inju- 
ries of the blood vessels, and are therefore an important 
remote cause of this disease. Contusions from horse-back 
riding ; hence this disease is common among troopers, and 
those who are much on horseback, such as medical men who 
reside in country situations, &c. I am now treating a gen- 
tleman of Xatchez, for a fistula in ano, who sustained an 
injury by his horse leaping over a bayou. The result was 
an tfnal abscess, and finally a fistula. Leech bites are some- 
times a cause of this disease; they are very liable, especially 



108 FISTULA IN ANO. 

if the general health is not good, to occasion suppuration in 
this situation, and finally to result in, fistula ; four or five 
eases of this kind have come under my own observation. Fis- 
tula sometimes follows the operation of lithotomy. Excrescen- 
ces about the anus, excoriations, stricture of the rectum, 
ulceration of the rectum, external violence. These are all 
causes of this disease ; injuries inflicted by the awkward intro- 
duction of the enema syringe, bougies, speculum, &c. I cured 
Mr. Kichard Lancaster, of Harrodsburg, Ky., in 1852, of a 
fistula in ano, produced by an injury from the pipe of an 
enema syringe. The records of surgery afford -numerous 
instances of this disease being caused by the presence of 
sharp-pointed foreign bodies, which are swallowed in food : 
such as pins, needles, fish bones, chicken bones, splinters of 
wood, small spiculee of bone, generally swallowed in broth 
made of fowl. 

These substances are detained in the rectum, or they make 
their way through its coats, and lodge in the cellular mem- 
brane, exterior to it; thus causing the most serious mischief 
by producing abscess and fistula. I have met with numer- 
ous cases of this kind. I am now (1846,) treating Dr. C. B. 
Black, of the firm of Massey & Black, druggists, New 
Orleans, who has a large fistulous abscess at the side of the 
anus, extending into the perinseum, from which I extracted 
a splinter of wood half an inch long. He had previously 
submitted to two extensive operations with the knife by an 
eminent surgeon of New Orleans, without affording the least 
relief, or any good result whatever. On one occasion I 
extracted a sharp-pointed piece of the breast bone (an inch 
long,) of a young chicken, from a fistulous abscess at the side 
of the anus. The patient, Joel Herndon, Esq., sheriff of 
Owen county, Ky., had previously undergone one operation 
with the knife, for his fistula in ano, without in the least 
being benefited. My friend Mr. H. was cured in 1839. See 



FISTULA IN ANO. 109 

his publication at the end of this chapter. In 1839 1 extracted 
a fish bone from a fistulous sinus; the patient being Mr. 
James D. Cook, of Bourbon, Co., Ky. In 1847 I also 
extracted a fish bone from an anal fistula. The gentleman 
was Mr. John W. Cheatham, near Henderson, Ky. Irrita- 
tion caused by the lodgment of indurated fasces or concre- 
tions in the rectum, are sometimes the cause of anal fistula. 
Gunshot wounds in this situation are also sometimes a cause. 

Symptoms of Anal Fistula. 

In some persons, the early symptoms of this disease are 
scarcely noticed, and the first thing the patient observes is 
the escape of matter ; in others, however, the first symptoms 
are severe, the patient begins to feel an uneasiness or pain 
in the rectum, he cannot sit comfortably ; as these symptoms 
continue to increase, he finds that his stools are voided with 
great difficulty, and that whilst voiding them, he suffers the 
most excruciating pain, and sometimes he is unable to pass 
his urine. All this time there may not be any external 
appearance of disease, but by pushing his finger up the 
bowel he will find some one spot exceedingly painful to the 
touch ; this is the place in which suppuration is going on. 
If the abscess is not lanced, it will sooner or later break of 
itself while straining at stool, and then the patient will be 
entirely relieved of all the pain, &c, but the discharge of 
matter will continue. In an external blind fistula, the patient 
sooner or later finds that an abscess, or as he would call it, 
" a hile" is forming near the anus, and usually to one side of 
it. In this, suppuration sometimes takes place very rapidly, 
with heat, redness, pain and swelling of the part ; at other 
times, it takes place slowly, and insidiously, without any 
sign of inflammation, so that the first thing that attracts 
attention, is a flat swelling, that results from the presence of 
fluid. The matter, if left to itself, sooner or later, by 



FISTULA IN ANO. 



absorption of the neighboring textures, makes its way to the 
surface. But as it is situated between the skin of the hip 
and the mucous coat of the bowel, it may effect evacuation 
through either the one or the other of these coverings. In 
conformity, however, to the general law, as to progressive 
absorption, occasioned by the presence of matters foreign to 
the healthy constitution of the body, it most frequently 
escapes by an aperture through the external integument. 
But the cavity of th£ abscess, though it contracts, does not 
become obliterated, but continues to discharge a matter of a 
thin, watery consistence, and the patient by this time 
becomes convinced that it is not a tile. f Indeed, it is the 
worst place in the world to have a bile located ! ! The mat- 
ter discharged varies, both in quantity and in quality. It 
often seems on the point of ceasing, when perhaps another 
abscess forms, or the same one opens and discharges and 
closes again, or at all events, no actual cessation takes place. 
Sometimes it has a very offensive smell, especially if the 
patient's general health, in other respects, is not good. It is 
sometimes of the most acrid character, and excoriates all the 
skin and mucous membrane with which it comes in contact. 
In a complete fistula, there is sometimes a discharge of wind, 
and when the fasces are fluid, portions pass through the pre- 
ternatural canal. 

In anal fistulas, as well as in anal abscess, there is some- 
times pain, lameness, and numbness, or wasting of one or the 
other of the legs ; doubtless caused by either the swelling of 
the parts extending or compressing the nerves which proceed 
to the leg through the corresponding side of the pelvis ; or a 
disease or a sympathetic affection of them. The arm may 
also be*" affected by the same causes, from these nerves being 
connected with those of the upper limb, through the medium 
of the intercostal nerve. 



FISTULA IN ANO. Ill 

Objectional Methods of Treating Anal Fistula. 

The methods resorted to for the cure of this disease, trom 
the days of Hippocrates to the present, are so numerous and 
so various, that the mere enumeration of them would be a 
task. I shall not attempt it, but confine myself to the con- 
sideration of a few of those to which I most seriously object. 
These are incision and excision by the knife ; cauterization 
by the red-hot iron and by caustic. 

The indurations and the callosities, consequent upon 
chronic inflammation, by which fistulous passages and ab- 
scesses are usually surrounded, were anciently considered 
malignant alterations of structure, and that they absolutely 
required a complete removal before a cure could be effected. 
These erroneous opinions led to the adoption of some of the 
most violent and barbarous methods, such as the complete 
extirpation of all the diseased or callous parts by the knife, or 
a destruction of them by the actual or potential cautery, or a 
•combination of all these means. It was this false notion that 
led Celsus to adopt the method of complete extirpation of the 
diseased or indurated parts. He was the first one who dis- 
sected out the whole parietes of the sinus. This method is 
still, at the present day, pursued by some of the French sur- 
geons. About four years ago, I treated a gentleman of 
Indiana for a fistula ani, who had previously submitted to 
this operation by a French surgeon, without being at all 
benefited. It was the same error that led Albucasis, Jean de 
Yigo, Durand Sacchi and Severinus, to apply the red-hot 
iron to the parts, after they had previously been laid open 
with the knife ; that induced Guy de Chauliac to make his 
incisions with a red-hot bistoury, introduced on a grooved 
sound ; that caused Leonidas carefully to remove all the callosi- 
ties by means of a forceps, a knife, and a peculiar speculum ; 
that led Dionis to scarify the indurations after previously 
having laid open the whole route of the sinus ; which last 



112 FISTULA IN ANO. 

method is still followed by some French surgeons. It is the 
same error that induces some surgeons of the present clay to 
use the actual cautery in burning out the disease. The cau- 
terization is adopted by means of an iron, corresponding in 
diameter to that of the sinus, and the temperature of which 
is scarcely elevated to that of red heat. This iron is pushed 
up the sinus, and in this way it is intended to burn out the 
disease. It is on the same principle that the various caustics 
are recommended, especially the caustic potash, or lapis 
infemalis, as used by Dr. Beach of New York, and his fol- 
lowers, for the cure of this disease. Dr. Beach says : " The 
peculiarity and difficulty of curing this disease is the hard- 
ness or callus which lines the sinus." {American Practice, 
Vol II , p. 189. New York, 1833.) Hence Dr. B. recom- 
mends the caustic potash, or a similar preparation for the 
destruction of this induration. I have, however, seen and 
treated many cases, some of long standing, that were entirely 
free from this hardness or induration, and found them to be 
as difficult to cure as those in which this induration existed. 
I have also in hundreds of instances removed this hardness 
or callous by the very mildest means, even when it resembled 
cartilage in hardness. This error, therefore, stands upon a 
supposition which is not true. The celebrated Pott, when 
speaking on this subject, says, " Imagining this callosity to 
be a diseased alteration made in the very structure of the 
parts, they had no conception that it could be cured by any 
means, but by removal by a cutting instrument, or by 
destruction with escharotics ; and therefore they immediately 
attacked it with the knife or caustic, in order to accomplish 
one of these ends ; and very terrible work, by their own 
accounts, they often made before they did accomplish it." 
(Pott's Surgery, Vol II, p. 203. Phil. Ed. 1818.) 



FISTULA IN ANO. 113 

The Knife Operation. 

The most popular and the most fashionable method among 
surgeons, and the one most universally adopted, is that by 
incision with the knife ; yet it does not necessarily follow, 
however, from these circumstances, that this method is the 
most scientific, the most rational, and the most effectual. 

Modern surgeons, unlike the ancient, contend that the 
great difficulty in curing an anal abscess, or an anal fistula, 
is not the callous or the induration by which it may be sur- 
rounded ; but it is the action of the sphincter ani muscles. 
This, say they, is the grand obstacle to the healing of all 
sores in this situation ; hence, they contend that nothing but 
a division of one or both of these muscles, by which they 
are set at rest for the time being, will ever effect a cure. If, 
indeed, the action of the sphincter ani muscles is really the 
cause of arresting the healing process in all sores in the anal 
region, as contended for, then surely the grand remedy, the 
knife, which can at once completely put to rest one or both 
of these muscles, must be the true, certain and rational 
method of treating those diseases ; for the theory and the 
practice exactly correspond. Now, all this certainly appears 
very plain, very simple, and very plausible,, and might to a 
superficial observer, be sufficient to convince him of its 
truth, and at once induce him to put it into practice, espe- 
cially, as the operation is one among the most simple and 
easy to perform in surgery. But I deny, however, that the 
action of the sphincter muscles is the chief cause, or indeed 
any cause in preventing the healing process in anal abscesses, 
or in anal fistulas ; and I deny too, most emphatically, that 
simply dividing with the knife these muscles, or the fistulous 
passages, is a certain and an effectual remedy for the cure of 
those diseases. It is most surprising that the continued and 
most signal failures of the knife operation in those instances 
have not induced more surgeons to pause and to inquire 



114 FISTULA IN ANO. 

whether there might not be something wrong, either in the 
theory, or in the practice, to account for the ill success that 
generally attends this operation. I assert it, and that too 
without the least fear of a successful refutation, that the 
chief causes which operate in preventing or arresting the 
healing process in the two diseases named, are the following : 
the depending position of the part ; the large amount of lax 
cellular membrane which invests the part, and in which 
granulation is always tardy ; the large number of veins that 
are distributed to this part, and their great liability to con- 
gestion ; the passage through the fistulous canals of either 
the thin portions of the feculent matter, intestinal gases, 
pus, mucus, or any thing else ; and the unfitness of the op- 
posing surfaces of the lining membrane of those abscesses, 
or fistulous passages, to unite, and thus become obliterated. 
These, I repeat, are the chief causes which tend to retard 
the process of granulation and of cicatrization in these dis- 
eases, and not the action of the sphincter ani muscles. 

The mode of operating for a complete fistula, according to 
Dr. Bushe, is as follows : " After the patient is placed in the 
usual position, for operating on this region, the surgeon 
should introduce his right or left fore-finger into the anus, 
according to the side affected ; then with a probe-pointed 
bistoury, he ought to traverse the sinus, and having placed 
the finger in ano, on the extremity of the bistoury, he should 
cut his way out, either by steadily depressing both hands, or 
else, by projecting the knife through the anus, and pushing 
it downwards, and to the opposite side. If the operator be 
inexperienced, he may first pass a director, and on it, the 
bistoury. When the fistula does not open externally, the 
surgeon (says Dr. B.,) may follow one of two methods in the 
performance of the operation. In the first, the orifice being 
discovered by the finger in ano, the operator should carry the 
knife along his finger, dividing the sphincters, &c. In the 



FISTULA IN ANO. 115 

second, having hooked a strong probe, and passed it into the 
fistula, he should press it down, until it appears by the side of 
the anus, and then cut on the extremity, so as to convert the 
incomplete into a complete fistula ; after which he ought to 
finish the operation with a probe-pointed bistoury, as above 
described." 

It is questionable whether this refined operation now really 
succeeds any better in curing a fistula in ano, than any of 
the ancient methods named ; whether with all the improve- 
ments of the day, with regard to superior instruments and 
modes of operating, a better knowledge of the anatomy and 
structure of the parts, the pathology, &c. ; whether, I repeat, 
with all these advantages, this operation really succeeds in 
curing this disease with any greater certainty, than the old 
operations already named ? But whether it does or does not, 
it is nevertheless gratifying to know that the nature of the 
operation, as anciently performed, has been greatly modified, 
and is much to be preferred to the methods already alluded 
to ; yet even in its modified form, and shorn as it is some- 
what of its most objectionable features, is still by no means 
free from pain, from danger and uncertainty, and must al- 
ways occasion a grievous infliction of uncalled for suffering. 
I care not, however, to what perfection it has been brought, 
or may be carried, it cannot succeed in the majority of cases ; 
the very principle is a bad one, and should therefore be 
abandoned. The following are my main objections to the 
knife operation. It is very ineffectual, very uncertain, even 
when performed by the .best surgeons, and under the most 
favorable circumstances. It has frequently to be repeated 
as often as two, three, four and five times, and even then 
failing. I am well acquainted with a highly respectable and 
intelligent gentleman of Louisville, Ky., a commission mer- 
chant, who submitted to twenty-two incisions for an ordinary 
fistula in ano, before he was cured. This gentleman might 



116 FISTULA IN ANO. 

have been cured in three weeks, without any incision. The 
operation is by no means as permanent in its results, as it is 
generally represented to be ; the numerous cases which I 
have cured, in which it had been fairly tested, and signally 
failed, attest in living characters how far it acts as a perma- 
nent mode of relief. The names of a few of these cases will be 
given at the end of this chapter. Indeed, I have an abun- 
dance of the most positive testimony, sufficient to fill a 
volume, to prove that this operation, in hundreds of instances, 
has utterly failed, even when judiciously performed by the 
most eminent surgeons in our country. Such, then," is the 
glorious uncertainty of an operation which is so often tri- 
umphantly referred to as being a complete and permanent 
cure of this disease. The following language of an eminent 
medical writer may with propriety be applied to this opera- 
tion. " The healing of the cut, and the dismissal of the 
patient, are not always synonymous with ultimate recovery. 
Too many patients are said to have been cured by opera- 
tions, which have ultimately failed. Those bloody beacons, 
like the false lights of wreckers, have Hazed but to betray ; 
and the surgeon and the patient have often been lured on, 
by their lying lustre, to perform and to submit to barbarous 
repetitions of equally unsuccessful butchery." 

The operation by incision, is attended with imminent dan- 
ger from haemorrhage. " Among the untoward consequen- 
ces," says D,r. Colles, " that may result from the operation, 
is that of hemorrhage, and you may not be immediately 
aware of its occurrence, because of the blood not coming 
out through the wound ; although there should be little or no 
bleeding externally, there may be internal bleeding. What 
are the symptoms that indicate this internal bleeding ? The 
patient complains of uneasiness about his rectum — he gets 
weak — he feels an inclination to make water, and tries to 
make it, but cannot — he strains a good deal, but not a drop 



FISTULA IN ANO. 117 

will come ; he has great desire to go to stool, which at length 
becomes so urgent, that he cannot resist it, and then he passes 
a large quantity of blood by the rectum, and perhaps falls 
off the night chair in a faint. Haemorrhage is one of the 
occurrences from this operation that should deter the surgeon 
from carrying his incision too high up ; as, if it extends 
above the upper margin of the deep sphincter of the rectum, 
there will be the dilated pouch of the gut, ready to receive 
a large quantity of blood, with diminished hopes of making 
an effectual compression on the bleeding part." I cured a 
gentleman of Pittsburg, Pa., a few years ago, of an exten- 
sive fistula ani, who was near losing his life from haemor- 
rhage caused by such an operation. The benefits conferred 
on him by the operation, were, that it destroyed the power 
of the sphincter muscle, so that he could not control his 
evacuations, and nearly destroyed his life, without curing his 
fistula. In some cases, the operation, in a short time, proves 
fatal ; particularly in diseases of the chest, from the effects 
of haemorrhage, even if slight. Nervous exhaustion, from 
loss of Mood, may be a cause of death after this operation. 
I noticed in the chapter on the anatomy of the rectum, that 
there is sometimes an enlarged or varicose condition of the 
proper veins of the anal region in old persons, and in those 
who labor under disease of those parts — such as fistula in 
ano, &c. In such cases, when these veins are divided, there 
sometimes follows the most alarming, if not fatal haemor- 
rhage. There is also great danger of serious bleeding, even 
if the incision is not extended high up, in cases of anal fistula 
of long standing, in which there is much induration of the 
parts. In such instances, the divided vessels are generally 
unable to retract, and consequently serious haemorrhage is 
the result. 

The operation is extremely dangerous, from inflammation. 
It not unfrequently proves fatal from erysipelatous inflam- 



118 FISTULA IX ANO. 

mation, which is so liable to extend itself along the mucous 
membranes. I once saw a case where this kind of inflam- 
mation spread rapidly up the rectum, in consequence of an 
operation on its lower extremity. It terminated fatally, as 
such cases usually do, when attacked by this kind of inflam- 
mation. This operation sometimes causes inflammation of 
the cellular tissue immediately exterior to the peritonaeum, 
and causes death. 

Indeed, it is not easy to pronounce on the amount of dan- 
ger from inflammation which may follow operations on the 
lower bowel. I have seen one, and read of several cases 
proving fatal from mere manual examination ; from the in- 
troduction of bougies, of the dilator, speculum, &c. Inflam- 
mation is liable from these causes, in some particular cases, 
to be produced, and extend to the loose cellular tissue, imme- 
diately external to the muscular tissue ; from this, it may 
extend to the cellular tissue external to the peritonaeum, and 
thus terminate in the destruction of the patient. 

Owing to the peculiar anatomical structure of the parts, in 
females, the operation is always hazardous ; especially if car- 
ried up into the rectum, in consequence of the peritonaeum 
being so differently arranged. When the sinus is anterior to 
the rectum, because of the proximity of the vagina, the 
operation may give rise to recto-vaginal fistula, a most aggra- 
vated case of which I cured a few years since, in a lady in 
Kentucky ; or it may occasion, as it most always does, per- 
manent inability to control the evacuations of the bowel. 
Quain, of London, in his work on diseases of the rectum, 
says, " I have been informed by Mr. Copeland, that he had 
under his care a female who for many years suffered from 
this grievous distress, (inability to control the evacuations,) 
and was rendered by it unfit for society, on account of a free 
incision in the direction adverted to, made by an eminent 
surgeon, for the cure of a fistula." — (p. 108). The other 



FISTULA IN ANO. 119 

sex are also liable to have this most grievous evil inflicted 
upon them by this operation. They are often, after submit- 
ting to it, rendered permanently incapable of retaining either 
the intestinal gases or their stools, and they pass involunta- 
rily. This truly is a most deplorable condition to be left in, 
even if cured of the anal fistula. Nineteen cases of this 
description have come under my own observation ; and in 
but five, was the original disease really cured. Let no sur- 
geon therefore tell me that such an effect cannot result from 
the operation, or that it is an exceedingly rare occurrence. 

This operation is objectionable on account of the pain ; 
indeed, it is one of the most painful operations in surgery, 
owing to the large number of nerves distributed to this 
region. This objection, however, in the majority of cases, 
is now obviated by rendering the patient insensible by chlo- 
roform. 

In order to give the reader some further information with 
regard to the beauties of this refined operation, as now prac- 
tised, and the necessity of the invaluable agent, chloroform, 
I will quote a few remarks from one of Dr. Colle's lectures, 
who was an uncompromising advocate for the knife in this 
disease, and who was for thirty years professor of surgery in 
the Royal College of Surgeons of Ireland. "Now, sup- 
posing a fistula had no opening into the rectum, that it was 
what is called a blind internal fistula, you will often find 
considerable difficulty in pushing the bistoury from the fistu- 
lous canal through into the rectum, and particularly if there 
was much distance or thickness of parts between them ; from 
pushing it in an awkward manner, I have more than once 
seen the knife break, and half its blade left in the wound. 
The manner in which you are to proceed is to scrape your 
way through, by repeated touches of the knife, until you 
come to the gut, when you can easily push it through its 
coats. Now, when you have gotten the point of the knife 



120 FISTULA IN ANO. 

into the gut, you are, of course, to cut it out, and this is a 
part of the operation that many surgeons bungle at ; — I have 
seen a surgeon use so much force, in pulling the knife 
through, that when, by some accidental turn of his hand, 
the knife suddenly cut its way out, he was near falling on 
his hack ; the way you are to cut through the parts is by a 
sawing motion, &c. There is another very different appear- 
ance of the external opening of a fistula from what I have 
described — instead of the little fungus projecting from th.e 
opening, and the opening itself small and hard, round its 
eages, you will sometimes find the opening a mere slit in the 
skin, the edges of which are flabby, and sometimes over- 
hanging — the slit is sometimes the length of the eye of the 
probe ; — if you operate on this patient, this will happen — 
that although your incision was but just of the proper extent 
when made, yet (and it is a curious fact) in a few days it 
will be like a chimney, so large that you can see up it, — 
there will be a profuse discharge from it, and dreadful pain. 
I remember a man coming to the hospital one morning, in 
this state, and one of the pupils, who just saw him, asked 
him if he was cut for fistula with a spade ! ! In such a case, 
the patient cannot live three weeks after the operation." 

The numerous failures, injuries and fatal terminations of 
this operation, should, like heacons, warn us of its danger, and 
urge us to the adoption of some other means for the cure of 
this disease. This we are conscientiously bound to do ; hence 
I prefer to cure this disease by the safest, mildest, simplest, 
most effectual and most unostentatious method; and the suc- 
cess of my practice in the treatment of this disease for the 
last eighteen years, forms the best corollary to the value of 
my method. There is, therefore, no necessity whatever for 
subjecting individuals to an operation, painful and hazardous 
in the extreme, frequently without any good result, but often 
much injury. I know from extensive experience, that it 



FISTULA IN ANO. 121 

holds out scarcely any chance of permanent benefit. What 
individual then, in his sober senses, will consent to have his 
rectum or anus, or both split open — to be confined, as in 
some cases, to his bed for weeks, — to be compelled to wash 
out the cut, after each stool, — to be subjected to repeated 
operations of the same kind, — and finally, liable to be ren- 
dered miserable for life, when he might be cured by a safe, 
mild and scientific method? For it cannot be denied that I 
have cured some of the worst forms of this disease, without- 
the knife or any other painful or dangerous remedy. I am 
well aware that many are induced to submit to the knife 
operation, by being assured that they will be more speedily 
cured ; but this is a great mistake. The operation is by no 
means the cure, as thousands have sadly experienced. Many 
patients, from hearing surgeons speak of the simplicity, the 
safety, the certainty and especially the dispatch of the opera- 
tion, at once imagine that the cut is the cure ; that the opera- 
tion is performed in a few minutes, and then all is over and 
all will be well ; that its achievements are like Csesar's con- 
quest, — " veni, vidi, vici." I, however, cure this disease just 
as rapidly as any knife operator can possibly do it. 

Such is a list — a very formidable one even on paper — yet 
a thousand times more so in practice, of the inefficiency and 
the dangerous consequences which attend the knife operation. 
A milder, safer and more certain substitute, candor must 
admit, would be a boon to humanity. Such a substitute I 
have practiced for the last eighteen years, and will, in a short 
time, present it to the profession in another work. 

The Method hy Caustics or Escharotics. 

This is one among the most ancient methods of treating 
fistulse, and was introduced as before remarked, for the pur- 
pose of destroying the induration which usually surrounds 
fistulous canals, and which was considered the great obstacle 



122 FISTULA IN ANO. 

to the cure of fistulas. Various caustic substances were used 
for this purpose, either in their concentrated form, or in solu- 
tion, or ointment ; and in order to introduce these caustics to 
the bottom of the fistulous passages, turimdce, or tents were 
made of different kinds of substances, corresponding in size to 
that of the sinuses. These tents were then charged or imbued 
with the caustic, and pushed into the fistulous canals, and 
their size daily increased until the passages were entirely 
destroyed. Or a solution of these caustics were injected into 
the sinuses. Fabricius ab Aquae Pendente in 1592, in his 
Latin Treatise on fistulas, recommends the caustic potash to 
be put on tents and put into the fistulous tubes ; he also 
recommends a solution of the same, which he calls lixivio 
dilutum. He also recommends the ligature, and says, " We, 
to draw the ligature the tighter, put in a little turn stick 
about the middle of the ligature ; and by turning this about, 
the ligature becomes twisted up extremely tight." Dr. 
Beach, of New York, in what he calls " The American Prac- 
tice" adopts precisely the practice laid down by Fabricius, 
for the cure of fistulas. Dr. Beach uses the caustic potash on 
tents in the same manner ; he also injects a solution of the 
caustic into the sinuses ; and when he uses the ligature, he 
tightens it precisely in the same manner, by twisting with 
a stick. Dr. B. also injects lye into the sinuses. 

" Weak lye," says he, " answers very well. The strength 
of it can be gradually increased as it may be required ; but 
there is no danger of using it very concentrated — for the cure 
is expedited according to its strength. This liquid should be 
injected once or twice a day." — {American Practice, vol., 2, 
p. 190.) 

We find that Galen recommended the same practice 
upwards of fifteen hundred years ago. 

" When the fistula is narrow and long," says Galen, " and 
does not appear to me to contain callus internally, but only 



FISTULA JN AXO. 123 

sordes, I first inject lye into it, and then allowing it to remain 
in the fistula until I expect that the sordes has fallen com- 
pletely off". I afterwards apply the medicine." — [Paulus ^Egi- 
neta, vol. 2, book iv., p. 123 : London, 1846.) 

We also find that this method was quite common in Eng- 
land in the days of Pott, about one hundred years ago. 

" Tear of hemorrhage," says Pott, " in making a large 
division of parts, and a design to destroy callosity, gave rise 
to the use of caustics for this purpose. By the introduction 
of them in different forms and manners into the sinuses, that 
part of the intestine which divides the cavity from that of 
the abscess, is intended to be destroyed, and thereby the pro- 
posed end of making one cavity of two, is to be accomplished, 
while at the same time the supposed callosity is to be wasted. 
For this purpose some of the most fatiguing and painful 
escharotics have been prescribed and used: thepulvis angeli- 
cus, the Lapis Lnf emails (caustic potash) and troches and 
pastes made with sublimate, arsenic, &c. But this method 
is so cruel, so tedious and so inexpedient, that I hope it is, by 
this time, totally out of use. It was founded in error, and 
tends only to mischief." — {Pottfs Surgery, vol. 2, p. 326.) 

" Dr. Daniel Turner," continues Pott, " who practiced 
surgery within these few years, used this method in its full 
extent. In his works may be found an account of his form- 
ing tents of the trochisci e' minio, and thrusting them into 
the sinuses, there to remain until they had produced a suffi- 
cient eschar." "This induration," says Pott, " and this sort 
of discharge, are often mistaken for signs of diseased callo- 
sity, and undiscovered sinuses ; upon which presumption, 
escharotics are freely applied, and diligent search is made for 
new hollows ; the former of these most commonly increases 
both the hardness and the gleet, and by the latter new sinuses 
are sometimes really produced ; these occasion a repetition 
of escharotics, and perhaps incisions ; by which means cases 



124 FISTULA IN" ANO. 

which were at first, and in their own nature, simple and easy 
of cure, are rendered complex and tedious." Pott continues, 
" The prcecipitatis ruber seems to have been the great exter- 
nal specific of most of our immediate predecessors, and to 
have been used by them for the very different purposes of 
destruction and restoration. With this, either in dry powder 
or mixed with unguent, the tents, pledgets, &c, with which 
they dressed the sores were spread and imbued. That the 
same practice too much prevails, they who please, may be 
convinced." 

Dionis says, " There lived in Paris in 1700, one Le Moyne, 
who acquired great reputation for the cure of fistulse. His 
method consisted in the use of caustics — that is to say, with 
a corrosive unguent, with which he covered a small tent, 
which he thrust into the ulcer ; by which he daily little by 
little, consumed the circumference, taking care to enlarge 
the tent daily ; so that by the widening of the fistula, he 
discovered its bottom. If he found there any callosity, he 
corroded it with his ointment, which also served to destroy 
the Coney Burrows^ (sinuses,) and at last with patience he 
cured many. This man died old and rich, by reason he made 
his patients pay very well for their cure, in which he was in 
the right ; for the public value things no otherwise than in 
proportion to the sum which they cost. Those who were 
affrighted at the thoughts of the scissors, threw themselves 
into his hands, and though the number of rascally pretend- 
ers is very great, they never yet want practice." {Libri 
Citati,jp. 411.) 

I object to the use of the " Vegetable Caustic" for the fol- 
lowing, a very few of the many reasons I have : — It is well 
known that caustic potash is one of the most powerful escha- 
rotics known, quickly destroying the life of the parts with 
which it comes in contact, and extending its action rapidly 
to a considerable depth beneath the surface. It is, therefore, 



FISTULA IX ANO. 125 

only fit for destroying excrescences, forming issues, &c. ; and 
this is the opinion, too, of some of the most eminent surgeons 
of Europe and America. When we take into consideration 
that the vicinity of the rectum and anus is invested with 
such an abundance of free cellular tissue, and that how very 
prone this tissue is to suppuration, the slightest causes some- 
times resulting in it, the very serious objections to such a 
powerful and penetrating escharotic applied to these parts, 
must at once be evident to the mind of every intelligent sur- 
geon. I have treated many cases, that had previously been 
treated for months by this most painful and torturous 
remedy ; and the consequence was, that not only was the 
disease not cured, but that it actually spread into the contig- 
uous parts. This, too, is almost an invariable result when the 
general health is not good. 

These are but a few of the numerous authorities that might 
be adduced to prove the antiquity and the injurious effects 
of the caustic method, and to prove, too, that Dr. Beach's 
" American Method" as it has been styled, never originated 
in America ; that neither " the principle" nor " the measures 
necessary to make it effectual" ever originated either with 
Dr. Beach or any of his cotemporaries ; but that it was prac- 
ticed by the ancients and by others, even down to the present 
day, with doubtless as much success, if any, as it has in the 
hands of either Dr. Beach or any of those who have adopted 
his method. 

The celebrated Pott reprobated in the strongest manner 
the caustic method; that is, the application of the potential 
fire in any, and in all of its forms, together with all other 
applications which tended in the least to produce irritation of 
the parts ; including the method of ligature and caustic com- 
bined. He also condemned, in no measured terms, the 
methods which proposed monstrous, cruel and dangerous 
operations with the knife. In short, he has done more to put 



126 FISTULA IN ANO. 

down those various and barbarous methods, and caused a 
greater and a more complete revolution in the treatment of 
fistula in ano, than any one surgeon previous to, or since his 
day. Such were the great improvements he made in the 
knife operation, that it was universally adopted, and his 
method has undergone but very slight changes since. 

The Method by Apolinose or Ligature. 

This method is as ancient as surgery itself. It was first 
described, and the manner of introducing it, given by Hip- 
pocrates, in his work — De Fistula. The ancient ligature 
used for this purpose, was composed of hemp or flax thread, 
two or three double, to which were sometimes added horse 
hairs. The moderns use silk thread, silver, gold or lead 
wire, &c. 

" Hippocrates directs us to pass a raw thread, consisting 
of five pieces, through the fistula by means of a probe, hav- 
ing a perforation, or a double-headed specillum, and to tie 
the ends of the thread and tighten it every day, until the 
whole intermediate substance between the orifice be divided 
and the ligature fall out. If it remain long, the thread may 
be sprinkled with the detergent powder, called psarum, or 
some such powder, and drawn in." (Paulus JEgineta, Vol. 
II, Book VI, p. 400.) "Hippocrates employed," says Dr. 
Coates, " a blunt pewter eyed probe which he armed with 
his ribbon of thread and horse-hair, and passing its extrem- 
ity into the rectum, he brought it down with the index 
finger of his left hand placed in the anus ; then withdrawing 
the probe by this extremity, the ligature was carried through 
the sinus and anal canal — its ends were tied externally in a 
sliding knot, and tightened as usual, from time to time, until 
the septum was completely divided. A similar mode is still 
in use, except the probe is now made of silver. The chief 
objection to it is the difficulty of bending the end of the 



FISTULA IN ANO. 127 

probe in the rectum without a very painful traction on the 
septum. This difficulty becomes greater when the internal 
orifice is located high on the rectum ; and it is insuperable 
when it rises above reach of the finger." {American Cyclo- 
pedia of Practical Medicine and Surgery ', Art. Alius, Vol. 
II, p. 144.) 

Celsus describes the method by apolinose, and says that it 
is slow, yet free from pain, but that it may be expedited by 
smearing the thread with some escharotic ointment. He, 
however, only proposes the ligature for blind external 
fistulas. The following is his direction for its introduc 
tion, &c. 

"In has demisso specillo, ad ultimum ejus caput incidi 
cutis debet : dein novo foramine specillum educi lino 
sequente, quod in aliam ejus partem, ob id ipsum perfora- 
tam, conjectum sit. Ibi linum prehendendum vincien- 
dumque cum altero capite est, ut laxe cutem, quae super 
fistulam est, teneat : idque linum debet esse crudum, et 
duplex triplexve, sic tortum, ut unitas facta sit. Interim 
autem licet negotia agere, ambulare, lavari, cibum capere, 
perinde atque sanissimo." (De Medicince, lib. VII, Cap. 
IV, Art. 4.) 

[The specillum (probe) being introduced into these, (fis- 
tulse) an incision should be made through the skin, on the 
extremity of it ; then from this new aperture the probe 
should be drawn out with the thread attached to its other 
extremity, perforated for that purpose ; then the thread 
should be seized and its two ends tied together, so that the 
skin over the fistula may not be too tensely held ; the thread 
should be raw, double or triple, and so twisted that it may 
form one ligature. In the mean time, the patient may 
attend to his ordinary business ; he may walk, bathe and 
take his food, as if nothing were the matter.] 

The following description of the ancient specillum, which 



128 FISTULA IN ANO. 

must have been a kind of double-headed probe or sound, is 
from Fabricius : 

" II nous suffit seauvoir que specillum (qui est le mot Latin 
de Celse) est un instrument long et rond', du cuivre, d'argent, 
on de plomb, dequel on sonde les fistules, ayant un de ses 
bouts plus large, et l'autre plus etroit en vulgaire Italien 
stilo. v (Chir. ii.) 

[It is sufficient for us to know that Specillum (which is 
the Latin word used by Celsus) is an instrument long and 
round, of copper, silver or lead, with which fistulae are 
probed, having one of its ends larger and the other straighter 
(or narrower) ; in Italian, stilo.~\ 

Albucasis approved of either the knife, the actual or the 
potential cautery or the apolinose, according to circumstan- 
ces. (Chir. ii., 80.) Avicenna used the apolinose, and in- 
ferred for this purpose twisted hairs or bristles of a hog, as 
they would not rot. (Hi., 18.) Ambrose Pare approved of the 
apolinose and incision. (Chir. ii., 380. Paris, 1614.) Fou- 
bert and Camper likewise practiced the apolinose — the one 
with a leaden thread, the other with a silk one. Guido de 
Cauliaco and Eogerius approved of the ligature. (Paulus 
jEgineta, Vol. II, B. VI, p. 402.) The following authori- 
ties can also be consulted on the subject of the ligature in 
the treatment of fistula in ano : Gackenberger. (Dissertatio 
de ligatura Fistidarum Ani. Gottingen. 1784.) Berndoff. 
(Dissertatio de ligatura FistulcB Ani. 4 to. Erlangae. 1806.) 
Lefevre. (Dissertation inaugurate sur la Fistidas a Vanus, 
suivie oVun nouveau procede pour enpratiguer V operation par 
la ligature. 4 to. Paris, 1813.) 

The great objection to the use of the ligature, as practiced, 
not only by the ancients, but also by the moderns, is the irri- 
tation and the pain that it occasions, as well as the length of 
time it requires to effect a cure. These have always been 
and still are grave and serious objections to its general use, 



FISTULA IN ANO. 129 

especially when combined with caustic, as was the ancient 
custom, and as is now practiced by Dr. Beach, of New 
York, when he does use the ligature. But is it not possible 
to improve the method by ligature, so as to overcome these 
difficulties, and obviate these objections? I think it is; 
indeed, I know it. It is well known that I sometimes use 
the ligature ; and have done so ever since 1836 ; and it is 
also equally well known, that in my hands, it is neither a 
painful nor a tedious operation ; and that the great objec- 
tions urged by surgeons against its use, as practiced gener- 
ally, do not by any means apply to the method I pursue 
in its use, as all my patients can testify upon whom I have 
operated. "When I use the ligature, I never combine it 
with any caustic or escharotic whatever. I use it in all 
cases in which the sinus enters the rectum some considerable 
distance up, which is by no means an uncommon occur- 
rence, nor is it impossible, the absurd and dogmatic assertion 
.of Monsieur Kibes to the contrary notwithstanding ; and in 
all cases in which the general health is not good. But I 
differ very materially in several essential points from the 
ancients, as well as the moderns, with regard to the mate- 
rial of the ligature, its thickness, its introduction, its tight- 
ening, its fastening, &c, matters of the greatest importance 
in its scientific and proper use. I do not use saddler's 
silk, either single or double ; neither do I effect the 
tightening " oy the sliding knot ;" " oy tying as firmly as the 
patient can hear f or "by rolling on or twisting with a 
piece of wood or metal;" or by the invention of Dr. Luke, 
of London, or the cork invention of Dr. Hill, of Cincinnati. 
All these are inconvenient, ill contrived, and most bungling 
methods. When I use the ligature in any case, the material 
is always raw silk, of which I make and use three particular 
sizes, which I have found applicable to all cases, the largest 
size being less than any ever used before for this purpose. 



130 FISTULA IN ANO. 

I have also a new method of introducing, of tightening and 
of fastening the ligature. These several highly important 
and useful improvements in the use of the ligature, I claim 
as my own, having practiced them ever since 1836, in the 
successful treatment of upwards of three hundred cases of 
fistula in ano. 

The peculiarities of my method are, that it occasions 
scarcely any pain whatever ; that a radical, a perfect cure 
is effected with much more certainty, with no danger what- 
ever, and in as short a time as it possibly could be done by 
the knife operation ; and in a much shorter time and with 
much less pain and inconvenience than by the caustic 
method ; that my patients at all times are enabled to attend 
to their business, not being confined at all to their beds or 
their rooms, nor prevented from freely exercising or moving 
about anywhere, by either pain or by complicated dressings. 
This is always of the greatest importance, especially if the 
general health is not good, where exercise in the open air is 
so very beneficial, and where the least confinement might 
be so very deleterious. These matters, however, and all 
others growing out of this subject, will be more thoroughly 
investigated in my forth-coming work on Anal and Kectal 
Diseases. 

Some of those surgeons who advocate the knife, and the 
knife only, in the treatment of anal fistulse, and who imagine 
that I use the ligature in all cases, are constantly in the habit 
of representing my practice as being the old and long dis- 
carded and exploded method of the ancients, which say they, 
is now entirely obsolete and completely substituted by the 
knife operation, and never practiced by any but by quacks, &c. 
If my method is really as they represent it to be, it certainly 
seems to succeed most admirably in my hands ; yes, equally 
as well, if not a great deal better, than the knife operation 
in their hands, which, by-the-by, is nearly as ancient as any 



FISTULA IN ANO. 131 

other. My method, as far as the ligature is concerned, is 
neither altogether ancient nor altogether modern ; but a com- 
bination of both. 

' I am never in the habit of undervaluing, in the least, what 
has been done, said and written on the subject of this disease, 
either by the ancients or by the moderns. I consider all 
that has been done, as so many stepping stones towards per- 
fection. 

It is too much the practice of the present day, for physi- 
cians to arrogate to themselves the whole merit of the pre- 
sent state of medical science, which they may have aided in 
improving ; wilfully shutting their eyes to the fact, other- 
wise sufficiently obvious, that they have merely made a few 
strides in advance of a great many which had been made 
long before them, by those who preceded them, and under 
much less advantageous circumstances. 

On the subject of this disease, no small degree of praise is 
especially due to the ancients, those noble Greek, Koman, 
and Arabian physicians, the representatives of three of the 
most intellectual nations of mankind, who first found the cor- 
rect road, and made no inconsiderable advancement in it. 

" Surely, every age," says the translator of Paulus iEgi- 
neta, " ought to endeavor to benefit by the experiments, 
whether successful or otherwise, of all preceding ones, 
instead of every generation commencing a new series of 
trials, and wandering over the same grounds, in search of 
truth which had been long ago discovered ; or, in stumbling 
through the mazes of error, without regarding the beacons 
set up by their fathers, to direct the footsteps of their de- 
scendants. If the wisdom of antiquity be entitled to high 
reverence in any case, it surely is so in medicine, founded, as 
this art especially is, on general observation and experiment." 

In 1845, Dr. Luke, a distinguished surgeon of the London 
Hospital, was very much in favor of the ligature in the 



132 FISTULA IN" ANO. 

treatment of fistula in ano, having treated nine cases by this 
method. He invented some instruments for introducing and 
tightening ligatures. No sooner was it known, however, that 
Dr. Luke was using the ligature in the treatment of this dis- 
ease, than his brethren pounced down upon him in a most un- 
merciful manner ; since then we hear nothing more of Dr. L. 
and the ligature, except that he now prefers the knife operation. 
Dr. L. evidently must have had but an imperfect knowledge 
of the use of the ligature, or he would not have so soon 
abandoned it ; unless by so doing he consulted his own ease 
and comfort. The truth is, the ligature requires considerable 
more attention from the surgeon than the knife operation ; 
hence he will be very apt to adopt that method by which 
his own ease and comfort would be promoted. And this too 
is one reason why so many surgeons denounce the ligature, 
or any method but the knife, especially those surgeons who 
live in large cities and have an extensive practice. They 
have only time to cut the fistula, and let it take its own 
chance ; if it gets well, why, well and good, if not, they can 
soon repeat a similar operation. In the language of John 
Bell, " Operations have come at last to represent as it were 
the whole science of surgery. The position of a pure ope- 
rating surgeon is one which is false to the profession, and 
dangerous to the patient. The cacoethes operandi totally 
destroys the requisite patience for a fair trial and investi- 
gation, and in place of a reliance upon the ordinary means 
of relief — the failure of which arises from non-perseverance 
in their employment, leads to the substitution of extraor- 
dinary and dangerous experiments." 

The knife operation for fistula has claimed the attention 
of the first surgeons in the world ; feelings in its favor, 
transmitted for years, and strengthened by education, have 
become peculiarly strong ; and it is only by the united 
influence of experience and observation that they can be 



FISTULA IN ANO. 133 

dissipated, and any other method become the subject of 
sufficient attention to be adopted. 

The advantages of the peculiar method I adopt in the 
treatment of fistula in ano, over the knife operation, consist 
in obtaining a cure more certainly, easily, safely, and in a 
shorter period of time ; in avoiding pain and the danger of 
haemorrhage, and in permitting the patients to continue their 
usual avocations ; and what is still more important, the 
advantages of my method are, that it can be effectually em- 
ployed in every variety of fistula, but especially in those 
cases in which the knife operation is extremely dangerous, 
ineffectual, impossible, or out of the question; such, for 
example, as burrow deeply into the soft parts around the 
anus, or extend high up into the rectum, and beyond the 
reach of the finger, or such as occur in consumptive patients, 
or that depend upon some disease or alteration of the 
ischium (hip bone), the coccyx, or sacrum, &c. 

The Natural Cure of Fistula in Ano. 

Spontaneous cures of anal fistulse are of rare occurrence ; 
yet occasionally an isolated case does occur, in which the 
fistula will close without any surgical interference. Such 
cases have been reported by several surgical authors, Pott, 
Ribes and Yelpeau among the number. I have met with 
four cases of this character in my practice, in each of which 
the fistula had been complete. The spontaneous cures of this 
disease convinced me most thoroughly at a very early period 
of my professional career, that it could most certainly be 
cured without the knife operation, as nature had most 
emphatically demonstrated ; although I had been taught to 
believe that which some of the most enlightened surgeons of 
the present day constantly teach, that to attempt to cure a 
fistula in ano without the knife, was both chimerical and pre- 
posterous ; or as Dr. Syme, of Edinburg more elegantly 



134 FISTULA IN ANO. 

expresses it — " The inefficacy of all remedial measures for 
curing fistula, except by the knife, still remains un ques- 
tioned, unless by inaccurate observers, or unprincipled 
empirics." (On Diseases of the Rectum^. 19: Edinbwrg, 
1854.) It would be well if this presumptuous dogmatist, Dr. 
Syme, would study nature's method of curing this disease, 
and learn from her the first lesson with regard to the correct 
treatment of it. 

The composition of the tissues composing fistulous passa- 
ges being contractile, they, like all other tissues of the organ- 
ism, contract as soon as they cease to give passage to any 
liquid or discharge ; their parietes approach each other, they 
unite and finally change into a fibro-cellular chord, which 
sooner or later, partially or entirely disappears. A case of 
this kind came under my own observation in ]STew Orleans, 
in March, 1847. A black boy aged twenty-five, the property 

of Mr. P , of South Carolina, died of pneumonia. Two 

years previously, however, this boy had a large and com- 
plete fistula in ano, which in one year afterwards had entirely 
closed up and got well without any medical or surgical treat- 
ment whatever. A post-mortem examination enabled me 
distinctly to feel the remains of the fistulous canal, which I 
completely dissected out. It measured three inches in 
length, and was from two to three lines in diameter — its 
parietes being firmly united, and having precisely the appear- 
ance and the feel of a chord. Since then two similar cases 
have come under my notice. 

It is in this way, then, that nature herself cures fistulous 
passages. A new action takes place in them, they gradually 
cease to give exit to their accustomed discharge, their cavity 
consequently contracts and becomes capillary, a union of 
their parietes takes place, and finally they are converted into 
a fibro-cellular mass, resembling a chord, which may sooner 
or later altogether disappear. A knowledge of these phe- 



FISTULA IN ANO. 135 

nomena, relative to fistula?, is of vast importance to their suc- 
cessful treatment. 

Letters from those afflicted with Fistula in Ano. 

The reader's attention will now be called to a few brief 
extracts from letters. These were written by those who 
labored under this disease ; and the object in publishing them 
is to familiarize persons with the nature, causes, symptoms and 
consequences of this formidable malady, and acquaint them 
with the results of the popular treatment of it ; so that they 
may avoid, as much as possible, both. Those persons speak a 
language which cannot be mistaken. They were not deceived 
themselves, neither can they deceive others ; as this is, by no 
means, an imaginary disease. By diffusing this kind of infor- 
mation, it is not the intention to excite the groundless fears of 
any, but to call their attention to the early symptoms, so that 
they may secure the best surgical aid that maybe near them, 
at an early stage of the disease. It will also go very far 
towards exposing the many empirics who are " going about, 
seeking whom they may devour ! " 

LETTER A. 

The following letter was written by Mrs. , who had 

a fistula ani, caused by leech bites, which her family physi- 
cian had applied to hemorrhoids. I subsequently cured her 
of her fistula, and she remains well to this present time, (now 
1855.) 

M , %., December 30, 1842. 

Dr. Bodenhamer : — Sir — I take the liberty of addressing you a few lines 
on the subject of my ill health. Since my father saw you, I have been 
mending slowly, and am now able to go about the house. Since I have got 
better of the piles, I have noticed an abscess formed inside of the bowel, 
which discharges a large quantity of matter daily. On the outside, there is 
a substance about the size of a pea ; it feels hard like a gristle, and by 
pressing on it, it causes the discharge of the matter from the inside. Some- 
times I thought that matter came out of this lump externally. The lump 



136 



FISTULA IN ANO. 



is situated at the back part of the anus, and immediately under the hack 
bone. It was at this spot that one or two of the leech bites never got well, 
and I am convinced that they caused this sore lump, and the abscess under 
it. When I stool, and immediately after, I suffer very severe pain. I am 
also troubled with a most distressing burning and itching of the parts, espe- 
cially at night. I expect to visit you in eight or ten days. Please write 
me immediately, and inform me how long you think I will have to remain 
under your treatment. Respectfully, &c. 



LETTER 
C- 



B 



-, Ohio, January 17, 1842. 

Dear Doctor : — Through the recommendations of the Rev. Mr. C . 

of the Reform Church, and the Rev. Mr. P , of the Presbyterian Church, 

I have been induced to address you. The object of my communication is to 
inform you that I have, what my physicians call, fistula in ano. I have 
had this disease about five months, and within this time, I have had two 

operations performed on me, with the knife, by Drs. L and M— — . It 

is unnecessary for me to describe my case, for I intend, as soon as I receive 
your answer to this letter, to visit you forthwith, determined never again to 
submit to another operation. The doctors proposed to operate again, stating that 
they think they did not cut up the bowel high enough, and that the next cut 
will cure me, &c. But each cut, so far, has rendered me worse, and I sin- 
cerely regret not having heard of you before submitting to those .horrid 
operations. 

The writer of the above letter was Mr. David Adams, who, 
at that time, kept an upholstery and furniture store in Cin- 
cinnati, Ohio. I cured him of an extensive fistula in ano, in 
the Spring of 1842 ; now thirteen years ago, — New York, 
May, 1855. 

LETTER C. 

C , III, April 16, 1842. 

I was first afflicted with fistula about fifteen months ago, after a long 
period of suffering from chills and fevers, peculiar to this climate. It 
remained in an inflammatory state, without any formations of matter, for 
about three months. Our physicians appear to have known little or nothing 
about it, merely recommending ointments, &c. It was very painful while 
sitting. In the summer of 1841, copious discharges commenced from a small 
orifice on the left side of the anus, and within a short distance of it. The 
discharge was of a bright yellow color, and, at times, very offensive indeed. 1 
washed it daily with castile soap and cold water. During this time, 1 



FISTULA IN ANO. 137 

was severely troubled with flatulency ; irregular shiverings, followed by 
great heat and night-sweats. Its progress since has been painful, trouble- 
some, and with aggravated symptoms ; the most disagreeable of which are 
a painful tenesmus or bearing down, occasional strong pulsations in the 
abscess, and offensive discharges ; leaving the neighboring parts much 
heated and irritated. It is probably a blind external fistula, as I have no 
sufficient evidence of an internal opening. I have been thus far particular 
in describing my case, so that you might form some estimate of it before I 
came on to see you. 

I never heard anything further from this gentleman. He 
was clerk of the court 'of . 

LETTER D. 

L G , Ohio. October 2, 1842. 

Dear Doctor : — In communicating with you, I need not make any apo- 
logy. The object of my letter is to inform you, that about one year ago, a 
very painful swelling commenced on the left side of the anus ; and while 
suppuration was going on in it, I suffered the most severe pain, attended 
with fever. In five days it pointed, and the matter was let out with the 
lancet. It continued to discharge, and in January, 1840, I had the usual 
operation performed with the knife, about two months after its appearance. 
The operation was, I think, judiciously performed, but it has not resulted in 
a cure. I confined myself to my room all winter, and thought the cavity 
was filling up well, but my hopes were blasted. It is now as bad as ever. 

The author of the above letter was Dr. "W. Shields, of 
Locust Grove, Ohio.. I cured him in the Spring of 1845 ; 
now ten years ago. 

LETTER E. 

V , La., July 27, 1841. 

Dr. Bodenhamer : — Dear Sir — A friend the other day, directed me to 
you, for advice in a case of fistula. At the present writing, it has been six 
weeks since the disease macje its appearance on the left side of the anus, in 
three places. For the last four weeks. I have had the advice of two able 
physicians ; they have operated with the knife ; but two of the cuts seem 
incurable ; it appears impossible to heal them. 

In a subsequent letter, dated September 1st, 1841, he 
writes : — 

Dear Doctor : — Your polite note, dated August 10, came duly to hand 
last Saturday. Please accept my thanks for your prompt reply. Relative 



138 



FISTULA IN ANO. 



to my case, at present, I scarcely know what to think 5 I am not well, and 

still under the advice of Drs. J and P , both skilful surgeons and 

practitioners. My situation is truly deplorable, the wounds are not healed 
up, and but little hopes of their doing so for weeks to come, and perhaps 
never. At this time, I cannot leave my business. It would be fatal to do 
so. Sometime in October or November, 1" will visit you, and put myself 
under your care. 

I regret exceedingly to say, that this gentleman, sometime 
after writing the above, and before visiting me, met with a 
serious accident, by which he lost his life. 



LETTER F. 

H , Ala., Jan. 6, 1841. 

Dear Sir : — My attention was called, a few days since, by a friend, to 
your card on fistula, &c. For more than four years I have been afflicted 
with fistula in ano. It formed without my knowledge, and first attracted my 
attention in consequence of its continued itching. Apprehending that it 
would ultimately impair my general health, I determined to undergo an 
operation with the knife. I went to Philadelphia, and placed myself in the 

hands of Dr. , an eminent surgeon. Upon examination, the fistula 

was found, after having passed up the rectum spirally, about two inches, to 
have entered the bowel. I was operated on in the usual way, but not suc- 
cessfully. I have recently discovered a new sinus, immediately opposite 
the old one. My surgeon says that my fistula was caused by the piles. 
But I was never conscious that I had piles ; for if I had, they never gave 
me a moment's pain. There is a constant discharge of matter from the 
sore, and I suffer very much pain, since the operation ; before, I suffered 
none. My age is thirty-three, and my general health good. 

This gentleman was a merchant. I never heard any thing 

more from him. 

LETTER G. 

C , Mo. } December 7. 1842. 

Dr. Bodenhamer : Dear Sir — I heard some time since, that you had 
cured Mr. Noah Spears of a fistula : he is personally known to me. This 
has induced me to address you on my own account. I have also the same 
disease. Several years ago, I noticed that something was wrong, from an 
intolerable itching, occasionally, about an inch from the anus, to one side. 
Some two years ago, I discovered that a small opening had formed, out of 
which a small quantity of acrid matter was continually discharged. This 



FISTULA IN ANO. 139 

has lately increased very much, and causes great pain. In other respects, 
my health is tolerably good. If nothing interferes, I shall visit yon as 
soon as the river opens, which, I fear, will not he before spring. 

The writer of the foregoing letter is my kind friend, Eli 
E. Bass, Esq. I cured him in Louisville, Ky., three months 
after the date of his letter, now twelve years since ; and he 
remains well to the present time, 1855. He resides near Co- 
lumbia, Boone Co., Missouri. 

LETTER H. 

M , Ala.. March 17, 1841. 

Dr. Bodenhamer : Sir — Having heard, through a valued friend in Ken- 
tucky, that you are very successful in treating diseases of the rectum and 
anus. I have taken the liberty of addressing you on the subject, being 
afflicted with that horrible disease called fistula. I have suffered dreadfully 
for about ten years with this malady, and have had recourse to various 
remedies, without receiving any benefit. Several physicians to whom I 
applied, have advised me to have recourse to the knife • but the pain, 
danger, and uncertainty attending this operation, have hitherto deterred me 
from it. It has now become very extensive j three sinuses having now 
formed, which extend considerably into the bowel. My age is fifty-five, 
and my general health not good. My situation is such, that it would be 
attended with great pain and inconvenience to me, if I have to go the dis- 
tance from here to where you reside. 

I never heard any thing further from this gentleman. He 
was a clergyman. 

LETTER I. 

F , Va., Aug. 16, 1841. 

Dear Doctor — I have just heard that you are remarkably successful in 
treating various diseases of the lower bowels. I have been laboring under one 
of those diseases called fistula, since March, 1 840, at which time there came a 
sore, about one inch from the anus, which gave me a great deal of pain 
until it broke out and ran freely. As it continued to discharge and not heal 
up. I became alarmed, and called on a physician, who examined it. and 
found that the sinus ran straight up into the intestine. He got his probe 
up about two inches. I had frequently before felt the wind come out of the 
external sore. The doctor tells me I cannot be cured unless this canal is 
laid open with the knife. I understand that you do not use the knife or any 
dangerous or painful remedy. I am a farmer, my age is forty-four, and my 



140 FISTULA IN ANO. 

general health tolerably good. I wish you to write to me as soon as you 
receive this, and say what time would be most favorable for me to visit you ; 
how long I will have to remain, and as near as you can, what my boarding 
in your place will cost, and what your bill will be, &c. ■ I forgot to name 
that this place breaks and heals up once almost every week. 

I cured this gentleman about two months after, the date of 
his letter, and two years after he still remained well. 

LETTER J. 

F j Ky., June 30, 1840. 

Dr. Bodenhamer : Dear Sir — Permit me, though a stranger, to inform 
you that I am afflicted with that tormenting disease, fistula in ano. I 
think it was occasioned by riding a hard-going horse. About eighteen 
months ago, a hard lump made its appearance at the side of the anus, like 
a bile, which was finally lanced by a physician, and which continued after- 
wards to discharge a thin, acrid matter. My general health is far from 
being good, and I am constantly suffering pain in the part, as well as in my 
back and hips. I have heard of your skill in the treatment of such dis- 
eases, and intend to call and see you. I am fearful of the knife. 

The writer of the above is a clergyman of the Methodist 
Episcopal Church. He subsequently called on me, and upon 
examination, I found a complete fistula in ano, complicated 
as I thought with phthisis. I advised him to defer having 
his fistula treated, until his general health improved, think- 
ing I would never see him again. I heard nothing further 
from him, until a few months since, to my great surprise, I 
saw him in this city, entirely restored to health. He informed 
me that soon after leaving me, his fistula, as well as his dis- 
ease of the chest, commenced improving, until he got well 
of both, without either medical or surgical treatment. Lou- 
isville, Ky., 1846. 

LETTER K. 

M , Ky., Jan. 12, 1838. 

Dr. Bodenhamer : Dear Sir — Though a stranger to you, I take the lib- 
erty of writing you on a subject of much importance to me. I was 
attacked more than a year ago with a disease called fistula. I was a per- 
fect stranger to such a disease, never having heard of it, until I inquired 



FISTULA IN ANO. 141 

of physicians. A tumor formed and broke, about an inch from the anus, 
which, I thought, was nothing but a bile, and had it not continued to dis 
charge matter, I would have still thought it a bile. I, at times, suffered a 
great deal of pain. All the surrounding parts are hard and callous, and 1 
can feel something like a cord under the skin, running towards the bowel. 
I have taken a great deal of medicine, and am very much reduced. For 
the last two or three years, I never have a stool without taking some kind 
of pills. I suffer much pain in my back and hips, and great derangement 
of the urinary organs. My eyes are also constantly sore ; and I have 
thought it was caused by this disease. 

The writer of the above is a farmer. I cured him about 
two months after the date of his letter, and he remains well 
to this present time, 1846. 

LETTER L. 

S , Ky. } May 5, 1841. 

Dear Sir — I have lately seen your card, in which you propose to treat 
all diseases of the rectum and anus. I have a disease which my physician 
tells me is fistula. About two years ago, a rising came on, situated between 
the lower end of the back-bone and the anus. When it was lanced about 
eighteen months ago, it commenced to pain me more than ever, and con- 
tinues to discharge freely ever since. I am now sixty-nine years of age, 
and if I was cured of this horrid disease, and could get my bowels regu- 
lated, I could still enjoy excellent health. I have taken bushels of pills 
within the last three or four years, to keep my bowels regulated • but they 
seem only to relieve for the present. 

This old gentleman was cured by me some short time after 
writing the above. I saw him in 1843 ; he was then well, 
and had no occasion to resort to his pills. 

LETTER M. 

C , Ky.j Nov. 17, 1839. 

Dear Sir — At the request of Mrs. T , of this county, I write you. 

She has a fistula in ano, which has now nearly spread all around the anus. 
She has been cut three times for this disease, all to none, but the very worst 

of purposes. The last operation was performed by Professor M , of 

C . The cut v was extended far up into the rectum. This last operation 

was performed last April, and the gash still remains unhealed, and a new 



142 FISTULA IN ANO. 

place is forming on the right side of the rectum, where there is a hardness 
and a constant large discharge. 

I never heard further from this case. Death, I suppose, 
relieved the patient. 

LETTER N. 

B C H , Va., Aug. 27, 1841. 

Dear Sir : — I see from your card, that you have met with great success 
in curing fistula in ano, without having recourse to the knife. I have had 
that disease about eight years, and have tried many remedies for the cure 
of it, without success. The knife I am determined never to submit to. 

The above was written by a highly respectable physician. 
I have never heard from him since. 

LETTER 0. 

M N , Tenn., Sept. 14, 1840. 

Dear Sir : — I have been plagued with a fistula for the last twelve 
months. A small lump came near my lower bowel, which troubled me 
much by itching, and occasionally a darting pain through it. I counselled 
a physician, who told me to leech it freely, which I did. It was also blis- 
tered, but all to no purpose. It finally broke, and it now issues a thin 
watery matter. The mouth of the opening shuts every now and then, and 
breaks out again and runs. While it runs freely, I do not suffer any pain, 
but as soon as the opening closes, it begins to pain me, until I either open 
it myself, or it breaks. When it pains me much, and wants opening, I 
frequently ride on horseback, which soon breaks it, and gives me relief. 
The matter often galls me very much, especially in warm weather. The 
opening is about an inch and a-half from the anus, and there is a gristly 
substance running from the opening up to the anus. I frequently find that 
the wind comes out of the opening, and when my discharges are thin, some 
little comes down from the bowel, and out of the opening. 

This gentleman I subsequently cured. 

LETTER P. 

R , N. C. Sept. 1, 1840. 

Dear Sir : — I have been kindly informed by a friend, of your great skill 
in the treatment of fistula and other diseases. I have been annoyed for 
several years with a fistula in ano. It has nothing peculiar in its charac- 
ter, it is a simple fistula, sometimes discharging freely, and at other times 
less so. I have consulted various physicians, and tried many remedies, all 



FISTULA IN ANO. 143 

to no purpose. The last physician whom I tried, was from New York. He 
told me he could cure me without the knife, which I was truly glad to hear, 
for I greatly dreaded the knife. He showed me Dr. Beach's work, in which 
he recommends the vegetable caustic ; it appears that Dr. Beach has cured 
many cases. This doctor commenced my case by Beach's plan, and con- 
tinued it for six months ; at the end of which time, I was rather worse 
than better ; and the treatment was almost impossible to bear. After he 
found that he could not cure me, he advised me to go to Dr. Beach j but I 
believe that I would rather be operated on with a knife, than to submit 
again to have it burned out with caustic. The object of my writing you 
is, to know whether your treatment is similar to Dr. Beach's, in this disease, 
as this same doctor who attended me, when I told him what I had heard of 
you, remarked that your method must be Beach's, he knew ; but the gen- 
tleman who informed me of you, said he thought it was not. I am fearful 
that the distance between us is too great, for me to visit you, if I conclude 
to employ you in my case, and if it is necessary for me to be with you. 

I never heard any more from tliis gentleman. With regard 
to my method of treating diseases of the rectum and anus, 
being Dr. Beach's ; there is nothing more foreign from the 
truth. This falsehood has been again and again repeated, 
especially at a great distance, where my treatment is not 
known. I neither cut nor hum out these diseases, but am 
opposed to both. 

LETTER Q. 

M , , July 20, 1844. 

Dr. Bodenhamer : Dear Sir — I lately saw a merchant from your city, 
who told me that you could cure fistula without the knife, and named many 
persons whom you have cured, some of them were well known to me. I 
have had that disease for the last two years. About two months before it 
broke out, I felt a dull heavy pain in the bowel, extending to the small of 
the back, and whenever I went to stool I suffered severely. My urine was 
high colored, and I could never pass it, only when I was sitting down, 
while at stooling. It completely disqualified me from business. I had two 
of the best doctors in this place, but they did me no good. I imagined that 
it must originate from my urinary organs, and concluded to visit a celebrated 

water-doctor ', (not a cold water doctor,) who resides at , and to whom 

persons from all quarters go, to be treated for all diseases. ^ He appears 

* In reading my friend's description of his water-doctor, the temptation was so 



144 



FISTULA IN ANO. 



to give pretty much the same medicine for all cases ; yet he is truly cele- 
brated for making many cures. I applied to him, and at once he told me 
that my disease was in my kidneys, and that he could soon cure me. I 
remained under his treatment about three weeks, and gradually grew 
worse, and at length got so bad, that I could not return home. I finally 
dismissed my water-doctor, and called in another physician, who gave me 
a large dose of pills, which operated very severely, and while straining at 
stool, an abscess near the lower end of my bowel broke, and about one pint 
of corruption came out at once. In eight days from this time, I was entirely 
relieved from all my pains and suffering, and enabled to go home. But this 
place has continued to discharge matter ever since, and has terminated in 
what I told you, fistula. 

This gentleman was cured by me six months after the date 
of his letter. 



Publications from Persons cured of Fistula in Ano. 

From the Western Citizen. 

Mr. Lyle : — Feeling myself under obligations to Dr. Bodenhamer, of 
this place, and believing it to be my duty to publish anything that might 
be of service to the afflicted, is my apology for troubling you with the fol- 
lowing short notice, to which I feel assured you will cheerfully give a place 
in your useful paper. 

In the year 1836, 1 was attacked with that terrible and obstinate disease, 
called fistula in ano, under which I labored for some months, suffering 
great pain. I was told by physicians that there was no cure but by an 
operation with the knife, and was preparing myself for it. In the Spring 
of 1837, I was advised by a friend to go and see Dr. Bodenhamer, and, 
although a little faithless, I went and submitted to his treatment about 
seven or eight weeks, in which time I was entirely cured, and have remained 
so ever since, which has been near nine months. 

My reason for not making this publication sooner, was for the purpose of 
letting time test the cure. Noah Spears. 

Paris, %., Feb. 26, 1838. 

great to quote Butler's description of Sidrophel, that I could not resist it. Butler 
writes — 

" To whom all people, far and near, 

On deep importances repair ; 

When geese and pullen are sedue'd, 

And sows of sucking pigs are chows'd ; 

When murrain reigns in hogs or sheep, 

And chickens languish of the pip ; 

When butter does refuse to come, 

And love proves cross and humorsome ; 

To him with questions and with urine. 

They for discovery flock, or curing." 



FISTULA IN" ANO. 145 

Eighteen years have elapsed since I discharged my friend, 
Mr. Spears, cured. He is still free from his old disease, and 
in the enjoyment of good health. 

From the Western Citizen. 

Mr. Lyle — Permit me, through the medium of your paper, to add my 
humble testimony in favor of the successful treatment of fistula in ano pur- 
sued by Dr. Bodenhamer, of this place. In performing this duty, I feel no 
ordinary degree of pleasure, I assure you. About two years and a half 
ago, I was attacked with this most obstinate and loathsome disease. It 
commenced by a tumor forming, about an inch from the termination of the 
rectum. This tumor was lanced, from which issued a large quantity of 
matter. It could not be healed, and upon examination there were found 
four or five sinuses (or openings) running in different directions. One of 
these penetrated the rectum very high up. These sinuses were lined with 
a hard, callous flesh, and they continued through one external opening, to 
discharge a thin and acrid matter. I applied to several eminent surgeons 
who all informed me that there was no other method of curing the disease, 
at all, but by an operation with the knife, and that in my case it would 
require quite an extensive and formidable operation, and that I must submit 
to this or die. I concluded, at that time at least, to run the risk of dying 
rather than run the risk of perhaps being killed by an operation with the 
knife ; believing it to be, from extensive testimony, a very inefficient 
method, at any rate, of curing the disease. As soon, however, as I knew to 
a certainty that Mr. Noah Spears, of this place, was effectually cured of 
this disease, by Dr. Bodenhamer, without the knife, I immediately sub- 
mitted to his treatment ; and although I did not, as I should by all means 
have done, follow his directions with respect to diet and 'exercise, yet he has 
perfectly cured me. It is now about three months since, during which time 
I have enjoyed as good health, and continue to do, as I ever did in my life. 
The number of cases that Dr. Bodenhamer has cured within the last year, 
renders it no longer a matter of controversy whether the disease can be 
cured without the operation of the knife. 

Franklin Hutchison. 

Paris, Ky., July 4, 1838. 

My friend, Frank Hutchison, has been cured about eight 
years, and is still in the enjoyment of perfect health, 1846. 

From the Western (Citizen. 
Mr. Lyle : Dear Sir — Having been cured of an inveterate fistula in ano, by 
Dr. Bodenhamer of this place, I feel it a duty I owe to him, as well as others 
who may be afflicted in the same way, to make it known to the public. 
10 



146 FISTULA IN ANO. 

Will you be so kind, therefore, as to publish this in your paper ? I was 
attacked with this disease, in October, 1837. It commenced by a tumor 
forming near the rectum, which finally broke internally, and was lanced 
externally, from which continued to issue a most acrid matter. The dis- 
charge continued to grow worse, which affected my general health very 
much. Hearing of the success of Dr. Bodenhamer in curing this disease 
without an operation with the knife, I determined to apply to him, and did 
so last April. Since about the first of October last, I have been entirely 
well, and my general health nearly as good as it ever was. I would 
recommend to any person afflicted with this disease, to apply to him, being 
firmly of the belief that his skill and method of cure cannot be surpassed. 
I might have added that I was not confined to the house during the time I 
was under Dr. B's. treatment, and might have attended to ordinary business. 

J. D. Cook. 
Bourbon County, Ky. Jan. 17, 1839. 

The following letter is from "W. Huston, Esq., of the late 
firm of January, Huston & Co., Maysville, Ky. Upwards 
of seven years ago I cured this gentleman, and it affords me 
great pleasure to announce that he is still in excellent health. 
1846. 

To the Editor of the Paris Citizen. 

Dear Sir — Aware, as I am, of the prejudices existing in the minds of 
many against Dr. Bodenhamer' s mode of treatment of the disease called fistula 
in ano, and that the use of the knife has been, and is still by many, regarded 
as the only effectual method of cure, I would here bear testimony to the 
fact, that I, with many others, have been cured — effectually cured of this 
disease, by Dr. Bodenhamer, and would now request you to publish in your 
paper, the following statement of facts in relation to my case : , 

" In the spring of 1837, I had a tumor formed near the rectum, resulting 
in a fistulous ulcer, which I regarded as a mere ulcer, and treated it accord- 
ingly. It, however, did not get well under the usual treatment, but conti- 
nued until September of the same year, when I had it probed and examined 
by my physician ; when we ascertained that a sinus had formed in the 
direction of the rectum, and terminating, as we supposed, just without the 
sphincter muscle. I was advised by my physician to have the sinus laid 
open with a knife, which was done to the extent that the sinus could be 
traced with a probe. After the expiration of some eight or ten weeks, the 
wound was healed, but it did not result in a cure of the disease. The dis- 
ease returned again much in the same form as at first, and continued so 
until the following spring, when I went to see Dr. Bodenhamer, of Paris, 



FISTULA IN ANO. 147 

Ky. I remained with him or under his care about six months, and had the 
delightful satisfaction of being cured of this very loathsome disease. The 
case with me was protracted unusually long, in consequence of the peculiar 
seat of the disease and difficulty of treating it. In many other cases that 
have come under the care of Dr. Bodenhamer, the cure was effected, to my 
own knowledge, in less than half the time. In my case, the deranged state 
of my general health operated, among other causes, to retard the cure. 

I cannot close this communication, without adding the expression of my 
unfeigned gratitude to Dr. Bodenhamer for his kind, gentlemanly, and unre- 
mitted attention to me while under his care. Very respectfully, yours, 

William Huston. 
Maysville. Aug. 6, 1840. 

The following is an extract of a letter written by Mr. 
Payne, a gentleman of Woodford county, Kentucky, whom 
I cured of a fistula in ano, to Mr. Evans, of Versailles, Ken- 
tucky, who had a brother laboring under the same diseaes, 
whom I since also cured, and who had been operated on three 
times with the knife. 

Woodford County, Ky., April 10, 1840. 

Mr. Evans : Dear Sir — 1 received your letter late yesterday evening, 
and hasten to comply with your request. I was attacked with a fistula in 
ano, about two years before I applied to Dr. Bodenhamer. It commenced 
by a small tumor forming, about one inch from the end 'of the rectum, caus- 
ing but little pain at first, not more than an itching : it at last broke out, 
and discharged a quantity of matter, and became so painful that I could 
scarcely sit at all. I became alarmed, and applied to Dr. Dudley, who told 
me what it was, and said I could not be cured in any other way than by an 
operation with the knife, and gave me medicine to prepare for it. While 
preparing for an operation, I made extensive inquiries, and learned to my 
satisfaction that it was dangerous and uncertain. I determined to let the 
disease take its course, and did so for a long time ; but it continued to grow 
worse : so much so. that I was confined in the house nearly ail the time, 
and a great portion of the time to my bed. I heard, by mere chance, that 
Dr. Bodenhamer, of Paris, Kentucky, was curing the disease without the 
knife. I applied to him one year ago last January, and he cured me in a 
short time. His treatment was quite mild indeed, and I was not confined to 
my room a single day. My general health is now as good as ever it was. 
I would advise your brother to go to Dr. Bodenhamer immediately, by all 
means, if he has to be hauled in a bed ; the sooner he goes, the better — as 
he has no time to lose. Dr. Bodenhamer has cured cases so far gone, that 
they were mere skeletons, and in a manner entirely helpless, and he has 



148 FISTULA IN ANO. 

restored them to perfect health. He has cured a number who have been 
operated on, some as often as four or five times, with the knife, and given 
out to die by other physicians. Tell your brother I will warrant him to be 
cured, and that in a short time, if his lungs are not materially affected. 
Boarding, in Paris, can be had for three dollars per week, and Dr. B's. 
charges are not by any means extravagant. The poor who are unable to 
pay, he cures for nothing. Respectfully, your friend, 

Lewis T. Payne. 

About eight years ago I cured nay friend, Mr. Payne, of 
Midway, Ky., and quite a recent letter from him announces 
that he is in excellent health, 1846. 

To the Editor of the Western Citizen : 

Dear Sir : — I feel a peculiar pleasure in giving my testimony in favor 
of the method pursued by Dr. Bodenhamer, of Paris, Ky., in treating fistula 
in ano, having been effectually cured of that disease by him. Sometime 
after the disease made its appearance on me, I applied to an eminent phy- 
sician of Maysville, who informed me that I must submit to an operation 
with the knife, in order to be cured ; but when the time arrived, I declined, 
fearing the result. I then put myself under the care of a physician who 
proposed to cure me without operating with the knife. He treated my case 
about four months ; but owing to the severity of the treatment, and the 
fact that I was getting no better, I determined to apply to Dr. Bodenhamer; 
I accordingly came to Paris and put myself under Dr. B.'s care, and remained 
about five weeks, during which time he cured me. His treatment was so 
mild that I scarcely suffered any pain whatever. My general health, too, 
commenced improving immediately, and is now as good as it has been for a 
long time. I would recommend all persons laboring under diseases of the 
rectum and anus, to apply to him, being assured that they will never regret 
it. Respectfully, yours, &c, 

Joshua Burgess. 

Mayslick, Mason County. Ky., Aug. 23, 1840. 

Six years ago, I cured my friend, Mr. Burgess, and he 
remains well to the present. Previous to my curing him, he 
had employed a physician who treated him according to Dr. 
Beach's method, caustic potash, <&c, 1846. 

To the Editors of the Louisville Journal : 

Gentlemen : — I feel that I would be guilty of a dereliction of duty in 
omitting to add my testimony to that of so many others, in confirmation of 



FISTULA IN ANO. 149 

the skill of Dr. Bodenhamer, of Paris, Ky., in the treatment of that most 
obstinate disease, called by surgeons, fistula in ano. Permit me. therefore, 
although a stranger, to request you to publish my cure in your extensively 
circulated paper : not only for the benefit of Dr. B., but for the benefit of 
those who may be afflicted in the same manner. All such I do earnestly 
request to make immediate application to him. He has cured a large num- 
ber, some of whom have been operated on with the knife, several times, 
without being at all benefited. 

About five years ago, I sustained an injury near the rectum (or bowel), 
by riding a wild horse. A tumor formed and broke, and left a large abscess, 
from which three sinuses (or openings) ran in different directions • one of 
which penetrated the bowel high up. These were hard and callous, and 
from them there was a constant discharge of thin and acrid matter. My 
general health suffered very much. I had a constant pain in my back and 
hips. All the physicians I consulted, advised me to be operated on with 
the knife, as the only method of cure. This I determined never to submit 
to, on account of its uncertainty, painfulness, and danger. I happened, by 
mere accident, to hear that Dr. Bodenhamer had cured Mr. William Huston, 
commission merchant, Maysville, Ky., who had been previously operated 
on ; and that he had cured many others without the use of the knife. I 
immediately left my home, (near Greencastle, Ind.,) and applied to him, 
and continued under his treatment about eight weeks, and a perfect cure 
was the consequence. His treatment was mild, and I was not confined to 
my room. Ambrose Day. 

Greencastle, Putnam Co., la., Feb. 2, 1840. 

I have just heard from Mr. Day. He is in excellent health. 
It is six years since he was cured, 1846. 

From the Frankfort (Ky.) Commonwealth, May 21, 1844. 

Owen Co., Ky., May 10, 1844. 
Mr. Editor : — Dear Sir — I may do the public some good, at least those 
who may be afflicted, as I once was, by calling their attention to the fact, 
that in January, 1839, 1 made application to Dr. Bodenhamer, then of Paris, 
Ky., but now a resident of the city of Louisville, to be treated for the dis- 
ease now quite common, called fistula in ano. This disease made its 
appearance on me in the Spring of 1838, during which time I had submit- 
ted to an operation, with the knife, for its cure. This operation, (as is too 
common in those cases,) instead of curing me, greatly tended to aggravate 
the disease. I was strongly urged to submit to another operation, by being 
told that nothing else would cure me ; in the mean time, I had heard of 
Dr. Bodenhamer, to whom I applied, as stated above, and the consequence 
was a perfect cure. This was done by no hazardous operation, with but 



150 



FISTULA IN ANO. 



little pain, and scarcely any confinement. It now astounds me when I hear 
of persons submitting to such uncertain, unnecessary, often dangerous, pain- 
ful, and always cruel operations for those diseases, when they might be cured 
by a much more scientific, rational, and effectual method, by Dr. Boden- 
hamer, whose experience, in such cases, is not surpassed by any physician 
in this country. Dr. Bodenhamer is a gentleman and a man of science, and 
justly deserves encouragement. Your friend, 

Joel Herndon. 

In a letter from my friend, Mr. Herndon, received a few 
weeks since, he announces that he remains entirely well, 
1846. 

From the Louisville Tribune. 
Dear Sir : — Having been afflicted with what is called a fistula in ano, 
for some four years, occasionally suffering very much, and feeling assured 
that unless the disease is cured, I must necessarily linger out my days with 
little profit to myself and fellow-man, I came to the conclusion to make an 
effort to be healed, and dreading the operation with a knife, I concluded to 
place myself under Dr; Bodenhamer, of Louisville, Ky., who advertises to 
cure without the use of the knife. I was under the doctor between five 
and six weeks, and am now perfectly well and healthy, and can say that I 
suffered but very little under the treatment. I would advise all those 
afflicted with the above disease, to call immediately on Dr. B., in whom 
they will find all the traits which characterize "the gentleman, philanthro- 



pist, and man of science. 



A. Hatchitt, Jr. 



Hebardsville, Ky n July 19, 1844. 

From the Louisville Tribune. 

Mr. Editor : — It is with great satisfaction I acknowledge my indebted- 
ness to Dr. Bodenhamer, of your city, for the excellent health which I now 
enjoy, bejjtig in as perfect health as I ever was. I was first operated on for 
fistula in ano, by the late Dr. H. G. D., of Brandenburg, Ky., without any 
benefit. I then placed myself under the care of Dr. G., of Louisville, who 
also operated on me with the knife. I remained under his care about a 
fortnight, without being benefited. I then placed myself under the care of 
Dr. B., and without the use of the knife or any painful remedy, I find 
myself relieved from any symptoms of the complaint. I have been work- 
ing hard, and using as much exercise on horseback and otherwise as I ever 
did, without any inconvenience or annoyance from the disagreeable dis- 

Yours with respect, 

Edward R. Hardisty. 

Brondenburg, Ky n July 25, 1844. 

I have just heard from both Mr. Hatchitt and Mr. 



FISTULA IN ANO. 151 

Hardisty. They are both in perfect health, and have been 
since I cured them, (1846). 

From the Scioto Gazette. 

Mr. Ely : — You will please give the annexed one or two insertions, and 
charge to our account. I feel it due to Dr. Bodenhamer, to make this 
statement to the public. His moral character is unimpeachable ; he. has 
never failed of curing those who come to him in time. 

Feeling assured that you would publish any thing calculated to sub- 
serve the interests of humanity or science, I would respectfully request you 
to publish the following facts : 

I have been laboring under haemorrhoids, or piles, for fourteen years 
past, the last four of which in their most aggravating forms. They finally 
terminated in what is called a fistula in ano, an abscess formed at the side 
of the anus or bowel, which broke internally, and externally, and dis- 
charged matter from both openings, thus making a complete fistula in ano. 

The sinus or opening in the rectum or bowel, was almost half an inch 
up the same. For about six months before I was cured of this most dis- 
tressing disease, I suffered the most excruciating pain, and a considerable 
portion of that time was confined to my bed. I was advised by my friends 
to submit to an operation with the knife as the only remedy. To this I 
could not consent, until I had at least tried other remedies. I accidentally 
heard of the successful treatment of Dr. W. Bodenhamer, of Paris, Ky. I 
wrote to a gentleman of that place, who kindly forwarded me the certifi- 
cates of several respectable men, who had been entirely cured by Dr. B. 
I determined at once to go to Paris, and put myself under his care. I 
arrived in Paris on the 21st of January last, and remained there just five 
weeks, and returned home, I am happy to say, " a sound man." My gen- 
eral health has improved very much. 

Dr. Bodenhamer's mode of treatment is very mild. I was not confined 
to my room a single day, was able to attend to ordinary business. During 
my stay at Paris, I became acquainted with several gentlemen who had 
been entirely cured of this disease, by Dr. B. Some of them had been 
operated on with the knife two or three times, without success. 

I would earnestly recommend those who are laboring under this dis- 
tressing disease, to avail themselves of the services of Dr. B. without delay. 
Respectfully, yours, George Porter. 

Piketon, Ohio, March 16, 1842. 

About three weeks since, I received a letter from my 
friend Mr. Porter, in which he says his health is excellent, 
(1846.) 



152 FISTULA m ANO. 

From the Quincy (III.) Whig, April 24, 1844. 

Mr. Editor — Dear Sir : — I take great pleasure in calling the attention 
of the afflicted to the card of Dr. Bodenhamer. which you publish in your 
paper. His acknowledged skill and success in the treatment of the dis- 
eases named in his card, need not my testimony to establish. I cannot, 
however, on the present occasion avoid expressing my decided approbation 
of both. Nearly two years since, I was attacked by what is called fistula 
in ano. A large abscess formed at the side of the lower bowel, and con- 
tinued to discharge matter until I was cured last fall by Dr. B. I was 
under his immediate care about six weeks ; was not confined to. my room, 
and suffered but little pain. I was induced to apply to Dr. B., by my 
friend Captain Gliem, of St. Louis, who was cured by him of the same 
disease, having previously submitted to two operations with the knife. 
My advice to all afflicted with any of those diseases, is to make immediate 
application to him, and I am certain that they will never regret it. By 
publishing this in your paper, you will confer no small favor on me, and 
subserve the cause of science and humanity. 

Respectfully, John Field. 

Quincy, III.. April, 1844. 

I received a letter from Mr. Field about one year ago. He 
was then in the enjoyment of excellent health, (1846). 

Glasgow, Ky., Sept. 18, 1845. 
Dr. Bodenhamer — Dear Sir — Yours of the 7th inst. was duly received, 
in reply to which I am happy to say to you that I am entirely restored to 
health, which no man can enjoy while laboring under that dreadful dis- 
ease called fistula; which disease I was greatly afflicted with; but by your 
superior skill as a physician, I am now clear of it, and feel no symptoms 
of its return. I am convinced that if all who are so unfortunate as to be 
afflicted in that way, were to call on you, that they would be entirely 
cured. Please accept my best wishes for your future prosperity, and suc- 
cess in healing the afflicted. Your friend, Chas. R. Crouch. 

I cured my friend Mr. Crouch, about one year previous to 
the date of his letter. He had labored under an obstinate 
fistula in ano, for several years. 

The gentleman alluded to in the following communica- 
tion, is Norman T. Cherry, Esq., of Cherryville, Tennessee. 
In 1841 I treated him for a desperate fistula in ano ; and the 
following letter from his brother, announces the gratifying 
intelligence that he is perfectly cured. 



FISTULA IN ANO. 153 

Ckerryville, June 25, 1845. 

Dr. Bodenhamer : — Dear Sir — Yours of the 30th ult. is at hand. You 
wish to know whether my brother's old disease is permanently cured. I 
am happy to inform you that it is. He says, however, at times he experi- 
ences some effects, not perhaps of his old disease, but a kind of itching 
humor — nothing more. He is entirely satisfied that his fistula is cured, 
and that it will not return. He would like however, to know of you 
whether this itching humor partakes any thing of the nature of fistula. 

He most cordially wishes you much success at your new place of loca- 
tion. I am most respectfully yours, 

C. W. Cherry. 

Little did my friend when writing the above letter in 

1845, think that he himself was to be attacked in 1851, of 

equally as extensive & fistula in ano as his brother's, and that 

I would in the spring of 1852, in New Orleans, cure him of 

the same ; yet all really came to pass. My friend C. "W". 

Cherry, Esq., resides in Memphis, Tenn., and remains well 

of his disease to the present time. New York, May, 1855. 

From the Louisville Journal. 

Messrs. Editors : As I am about to leave your city, after having been 
cured of a most inveterate disease, will you be so kind as to permit me to 
make a few remarks relative to it through your valuable journal. About 
four years ago, I was attacked with a disease called fistula in ano, which 
completely disqualified me from attending to my business. For four long 
years I have suffered the most intense pain from this wretched disease, and 
from the treatment adopted by the various surgeons and physicians that I 
employed in my case. I have been operated on with the knife by the most 
eminent surgeon of Cincinnati, where I reside, and I have been burned, 
repeatedly burned, with the various kinds of caustic, &c, but all to a worse 
than useless purpose. About five weeks ago, I placed myself under the 
treatment of Dr. Bodenhamer, of your city, who has entirely cured me, 
without knife, caustic, or any other painful remedy. 

Very respectfully, yours, &c. A. Wilson. 

Louisville. July 5 , 1847. 

The following letter was from the late and lamented Judge 
L. Saunders, of Clinton, La., who was truly one of nature's 
noblemen. The Judge died of chronic diarrhoea, at some one 
of the Virginia springs, in 1848. In the fall of 1811, he was 
successfully treated by me for a very extensive fistula in ano 



r 



154 FISTULA IN ANO. 

of ten years standing. He had previously consulted two of 
the first surgeons in New Orleans, who proposed treating his 
case by the knife operation ; but the Judge declined the 
operation, and visited me at Paris, Ky., and placed himself 
under my treatment. 

Clinton, La., January 17 tk, 1842. 

Dear Doctor : I am most happy to inform you that I continue entirely 
free from any evidence whatever of a return of my old enemy, the fistula. 
When I wrote you, in November last, I had some little fears, as the parts 
still remained a little tender. This tenderness has, however, long since 
entirely disappeared, and I am now satisfied that the cure is complete, as 
it is more than three months since you dismissed me cured, it being on tlje 
fifth of October last. I assure you, doctor, I never cease to think of you, 
and of the very safe, simple, painless, but yet effectual manner by which 
you succeeded in curing me of this disagreeable disease. I universally 
recommend you to all my friends who are afflicted with any of the diseases 
for the cure of which, you are so distinguished. 

Continue, my dear friend, to accept assurances of my most cordial 
respect and esteem. L. Saundjgrs. 

Dr. W. Bodenhamer, Paris, Ky. 

The following note was from my friend, the late and 
lamented Col. Butler, one of South Carolina's noblest sons, 
who gloriously fell in the battle of Churubusco, in Mexico, 
on the 20th of August, 1847. I treated Col. Butler at Louis- 
ville, Ky., in the summer of 1846, for a complete fistula in 
ano. His disease was caused by chronic diarrhoea, which he 
had contracted whilst in Texas, treating with the Indians, he 
having been one of the commissioners appointed for that 
purpose. His note is without date, but was written some- 
time in December, 1846, whilst on a visit to New Orleans 
from Mobile, where his regiment was quartered previous to 
leaving for ^lexico. 

St. Charles Hotel, Wednesday evening. 

Dear Doctor : — I called at your office this morning ; but you were not 
in. I leave for Mobile to-morrow, and as I shall be very busy, please call 
at my room, adjoining the gentleman's parlor at nine o'clock, A. M., as I 
am very anxious to see you, and to introduce you to one of the officers of 



FISTULA IN ANO. 155 

our regiment, who wishes to consult you in relation to his father. As 
regards my own case, I am entirely well of the fistula, ever since the first 
of September last. The fistula did not entirely heal for several weeks 
after I left you, doubtless in consequence of the irritation kept up in the 
parts by occasional returns of diarrhoea. I have frequently spoken of you 
and your method of treating those diseases, to several of my friends who 
are afflicted, some of whom will no doubt consult you. 

Very truly yours. P. M. Butler. 

Dr. Bodenhamer. 

Cases of Fistula in Ano Cured. 

The reader's attention is respectfully called to the follow- 
ing, a few more of the numerous cases of Fistula in Ano, 
which have been successfully treated by my peculiar method. 
Were I, however, to detail all the cases I have cured of this 
one disease alone, during the last nineteen years, they would 
fill a good sized volume. By far the largest number of the 
cases here presented, had previously been examined or had 
undergone treatment by other surgeons and physicians. No 
names of ladies will be given in this work ; and those only 
of gentlemen who have voluntarily proffered them to the 
author for the good of the cause. 

Case 1. James M. Allington, blacksmith, Flat Bock, Ky. ; 
cured during the summer of 1838. 

Case 2. James B. Blair, aged 45, farmer, Moorefield, Ky. ; 
cured in the fall of 1838. 

Case 3. David Trimble, aged 41, farmer, Nicholas Co., 
Ky. ; cured in the fall of 1839. 

Case 4. Charles Timberlake, aged 37, saddler, Paris, Ky.; 
cured in the fall of 1839. 

Case 5. Abraham McNees, aged 63, farmer, Harrison 
Co., Ky. ; cured in the winter of 1840. 

Case 6. Joseph Paxton, aged 36, carpenter, Paris, Ky. ; 
cured in the fall of 1840. 

Case 7. Daniel Smith, aged 32, constable, Nicholas Co., 
Ky. ; cured in the fall of 1840. 



156 FISTULA IN ANO. 

Case 8. Col. Philip C. S. Barbour, aged 54, farmer, Old- 
ham Co., Ky. ; cured in the fall of 1840. 

Case 9. J. D. Towles, aged 16, Lewis Co., Ky. ; cured in 
the summer of 1840. This boy was previously twice operated 
on with the knife. 

Case 10. Stephen B. Tilden, Jr., aged 17, Chester, Illi- 
nois ; cured in the spring of 1841. 

Case 11. Eobert H. Tarlton, aged 19, Brookville, Ky. ; 
cured in the spring of 1841. 

Case 12. Edmund B. Barker, aged 35, plasterer, Wil- 
liamsburg, Ky. ; cured in the summer of 1841. 

Case 13. William Kagland, aged 28, merchant, Car- 
thage, Tenn. ; cured in the fall of 1841. 

Case 14. David Fort, aged 53, farmer, Smithland, Ky. ; 
cured in the fall of 1841. 

Case 15. Isaac H. Jones, aged 44, farmer, Triadelphia, 
Ya. ; cured in the fall of 1841. 

Case 16. Allen D. Miller, aged 34, farmer, Fulton, Mo. ; 
cured in the fall of 1841. 

Case 17. Robert L. Wright, Esq., aged 26, farmer, Wheat- 
land, Loudon Co., Ya. ; cured in the fall of 1841. 

Case 18. James Sidener, aged 40, farmer, New Washing- 
ton, Indiana ; cured in the fall of 1841. 

Case 19. B. F. Wiggington, aged 28, farmer, Columbia, 
Mo. ; cured in the fall of 1842. 

Case 20. Thomas P. Duvall, aged 30, machinist, Bourbon 
Co., Ky. ; cured in the summer of 1842. 

Case 21. Peter Sapp, aged 19, farmer, Bourbon Co., Ky. 
cured in the fall of 1842. 

Case 22. Mr. Kennar., aged 30, farmer, Pembroke, Ky. ; 
cured in the fall of 1842. 

Case 23. Z. M. Blackford, aged 27, farmer, Saluda, Indi- 
ana ; cured in the winter of 1843. Mr. B. had previously 
been operated on with the knife. 



FISTULA IN ANO. 157 

Case 24. John G. Camp, Jr., lawyer, Sandusky city, 
Ohio ; cured in the spring of 1843. 

Case 25. B. B. Ellis, aged 34, planter, Eodney, Miss. ; 
cured in the fall of 1843. Mr. E.'s case was of six years 
standing, and quite extensive. 

Case 26. Captain J. H. Gleim, St. Louis, Mo. ; cured in 
the summer of 1843. Capt. G. had been twice operated on 
with the knife, and much injured. 

Case 27. A. S. Swearengen, Esq., commission merchant, 
St. Louis, Mo. ; cured in the summer of 1843. 

Case 28. William P. Gray, aged 38, blacksmith, Bards- 
town, Ky. ; cured in the fall of 1843. Mr. Gray was shot 
dead by E. L. Wickliffe, Esq., on the 9th of August, 1849. 

Case 29. Hon. M. V. Thompson, aged 40, Lieutenant 
Governor of Kentucky, Georgetown, Ky., cured in the spring 
of 1844. Mr. T. had both fistula and piles. 

Case 30. Jonathan Mc Caleb, aged 58, planter, Port Gib- 
son, Miss. ; cured in the summer of 1844. 

Case 31. Thomas J. Likens, aged 27, sheriff of Washing- 
ton Co., Miss., Princeton, Miss. ; cured in the summer 
of 1844. 

Case 32. J. A. Gray, aged 31, grocer, Louisville, Ky. ; 
cured in the summer of 1844. 

Case 33. William Montmullen, aged 4, son of John Mont- 
mullen, Esq., of Lexington, Ky. This noble little boy was 
cured in the spring of 1844. 

Case 34. General A. S. Burnett, merchant, New Albany, 
Indiana ; cured in the summer of 1844. 

Case 35. Mary E. Clark, aged 2, daughter of Mr. Clark, 
merchant, of Golconda, Illinois ; cured in the fall of 1843. 

Case 36. Benj. S. Tuley, Esq., near Few Albany, Indi- 
ana ; cured of a most aggravated fistula ani, in the summer 
of 1842. Mr. T. had submitted to two incisions previously, 
with no good result. 



158 FISTULA IN ANO. 

Case 37. Thomas Haynes, aged 45, merchant, Louisville, 
Ky. ; cured in the fall of 1844. , 

Case 38. James Buchanan, aged 40, farmer, Charlestown, 
Indiana ; cured in the spring of 1845. Mr. B. had the dis- 
ease fifteen years, and was once operated on with the knife. 

Case 39. Captain J. E. Hamilton, aged 30, Louisville, 
Ky. ; cured in the spring of 1845. 

Case 40. John Evans, aged 49, farmer, Clark Co., Indi- 
ana ; cured in the spring of 1845. 

Case 41. William Lientz, aged 70, farmer, Rocheport, 
Mo. ; cured in the spring of 1845. Mr.. L.'s fistula ani was 
of twenty years standing. 

Case 42. John Tyson, aged 45, engineer, New Orleans ; 
cured in the summer of 1845. 

Case 43. Hon. Albert G-. Hawes, aged 45, farmer, Owens- 
boro, Ky. ; cured in the summer of 1845. 

Case 44. William E. Dickson, aged 18, farmer, Williams- 
burg, Ky. ; cured in the summer of 1845. Mr. D. was twice 
operated on with the knife previously. 

Case 45. Thomas J. Rogers, aged 40, clerk, Louisville, 
Ky. ; cured in the summer of 1845. 

Case 46. Calvin M. Rutherford, aged 35, New Orleans ; 
cured in the summer of 1845. Mr. R. had previously been 
operated on, in Louisville, with the knife. 

Case 47. J. D. Darlington, aged 47, clerk, West Union, 
Ohio ; cured in the summer of 1845. 

Case 48. Austin L. Peay, aged 42, farmer, near Louis- 
ville. Ky. ; cured in the fall of 1845. 

Case 49. Major Jacob Hikes, aged 62, farmer, near Louis- 
ville, Ky. ; cured in the fall of 1845. 

Case 50. William Boyd, aged 22, Boston, Mass. ; cured 
in the winter of 1846. Mr. B. was twice operated on with 
the knife previously. 

Case 51. Lewis Beard, aged 41, Aldie, Loudon Co., Ya. ; 



FISTULA IN ANO. 159 

cured in the winter of 1846. Mr. B. has been a clerk in some 
of the departments at Washington City for a number of 
years. 

Case 52. Charles Hall, aged 35, engineer, New Orleans ; 
cured in the spring of 1846. < 

Case 53. C. B. Black, aged 37, druggist, New Orleans ; 
cured in the fall of 1846. Mr. B. was of the firm of Massey 
& Black. He was twice operated on with the knife pre- 
viously. 

» Case 54. Capt. H. G. McComas, aged 35, Cincinnati, O. ; 
cured in the summer of 1846. 

Case 55. M. W. Shields, Esq., aged 40, farmer, Eockford, 
Indiana ; cured in the summer of 1846. 

Case 56. Richard Wabbar, aged 63, cooper, Louisville, 
Ky. ; cured in the fall of 1846. 

Case 57. M. L. R. Hovey, aged 32, cabinet-maker, Ches- 
ter, Ohio ; cured in the fall of 1846. 

Case 58. Jared Davis, aged 30, steamboat steward, Cin- 
cinnati, Ohio : cured in the fall of 1846. 

Case 59. John W. Cheatham, aged 40, farmer, near Hen- 
derson, Ky. ; cured in the fall of 1846. His fistula ani was 
caused by a fish bone. 

Case 60. James Miller, aged 45, pedler, Louisville, Ky. ; 
cured in the fall of 1846. 

Case 61. G. A. Turner, aged 30, shoemaker, Louisville, 
Ky. ; cured in the fall of 1846. 

Case 62. G. M. Kightley, aged 26, farmer, Lagrange, Ky. ; 
cured in the fall of 1846. 

Case 63. Conrad Melzer, aged 30, sailor, Germany ; cured 
in the spring of 1847. This man had been previously operated 
on with the knife in the Marine Hospital at Mobile, Ala- 
bama. 

Case 64. T. L. Wheat, aged 39, farmer, Salvisa, Ky. ; 
cured in the summer of 1847. 



160 FISTULA IN ANO. 

Case 65. W. G. Pitts, aged 30, farmer, near Shelbyville, 
Ky. ; cured in the summer of 184:7. 

Case 66. Capt. James W. Goslee, of the steamer Auto- 
crat, Memphis, Tenn. ; cured in 1847. 

Case 67. William Eagsdale, aged 31, Memphis, Tenn. ; 
cured in the summer of 1846. 

Case 68. Jacob Crizer, aged 50, livery stable, Natchez 
Miss. ; cured in the summer of 1846. 

Case 69. Col. T. L. Alexander, U. S. Army ; cured in the 
fall of 1846. He had previously been operated on with the 
knife, but not cured. 

Case 70. John J. Sheridan, aged 48, cabinet maker, Lou- 
isville, Ky. ; cured in the summer of 1847. 

Case 71. A. H. Eighter, Esq., aged 49, State Surveyor, 
Donaldson ville, La. ; cured in the summer of 1847. 

Case 72. William S. Townsend, aged 32, clerk of Circuit 
Court, Greencastle, Indiana ; cured in the summer of 1847. 

Case 73. Samuel Sterett, aged 39, Philadelphia, Pa. ; 
cured in the summer of 1847. 

Case 74. William E. Hughes, Esq., Editor " Louisville 
Democrat;" cured in the fall of 1847. My friend, Mr. H., 
had previously been operated on with the knife. 

Case 75. John Noel, aged 55, farmer, near Mt. Yernon, 
Indiana ; cured in the spring of 1847. 

Case 76. G. Y. Raymond, hat merchant, Louisville, Ky. ; 
cured in the spring of 1847. Mr. R. had previously been 
treated in New York by Dr. W. Beach. 

Case 77. M. M. Cannon, aged 26, carpenter, Harrods- 
burg, Ky. ; cured in the summer of 1 847. 

Case 78. A. S. Edrington, druggist, Lexington, Miss. ; 
cured in the fall of 1847. Mr. E. had previously been ope- 
rated on with the knife by Dr. G , of Louisville. 

Case 79. William G. Davis, aged 38, tanner, Elkton, Ky. ; 






FISTULA IN AXO. 161 

cured in the summer of 1S47. Mr. Davis now resides at 
South Carrolton, Ky. 

Case 80. Aaron Mitchell, aged 50, farmer, Mayslick 
Ky. ; cured in the fall of 184r7. 

Case 81. E. Justice, aged 47, farmer, Carpenter's Mills 
Ky. ; cured in the fall of 1847. 

Case 82. William Scott, aged 55, farmer, New Franklin 
Mo. ; cured in the fall of 1847. 

Case 83. Col. W. J. Oldham, aged 55, planter, near Mem 
phis, Tenn. ; cured in the winter of 1848. 

Case 84. E. Milliken, aged 37, sugar broker, New Or 
leans ; cured in the winter of 1848. Mr. M. had been pre 
viously operated on with the knife. 

Case 85. H. M. Hyams, Esq., lawyer, New Orleans 
cured in the winter of 1848. 

Case 86. T. R. Patten, Esq., planter, Lake Providence 
La. ; cured in the winter of 1848. 

Case 87. John Finley, aged 37, grocer, Lexington, Ky. 
cured in the fall of 1848. 

Case 88. Thomas L. Talifaro, aged 22, merchant, Paris, 
Ky. ; cured in the spring of 1848. 

Case 89. W. H. Grafton, Jr., merchant, New Cumber- 
land, Ya. ; cured in the summer of 1848. 

Case 90. Harvey A. Rogers, aged 35, farmer, near North 
Middletown, Ky. ; cured in the summer of 1848. 

Case 91. W. F. Colston, aged 35, merchant, Louisville, 
Ky. ; cured in the summer of 1848. . 

Case 92. James G. Robinson, aged 35, farmer, near War- 
saw, Ky. ; cured in the summer of 1848. 

Case 93. J. C. Hemingray, aged 27 T lawyer, Hopkins- 
ville, Ky. ; cured in the fall of 1848. 

Case 94. John J. Barwise, aged 27, New Orleans ; cured 
in the fall of 1848. 

11 



162 FISTULA IN ANO. 

Case 95. A. Borie, aged 37, confectioner, Louisville, Ky. ; 
cured in the fall of 1848. 

Case 96. Dr. Peter B. Mason, aged 42, farmer, near Dan- 
ville, Ky. ; cured in the fall of 1848. 

Case 97. Isaac C. Yanarsdall, aged 45, constable, Har- 
rodsburg, Ky. ; cured in the winter of 1849. 

Case 98. Philip Zaring, aged 21, farmer, near JSTew Phi- 
ladelphia, Ind. ; cured in the spring of 1849. 

Case 99. Peter Carnes, aged 37, farmer, near Cincinnati, 
Ohio ; cured in the spring of 1849. 

Case 100. Thomas Dewitt, aged 58, farmer, Murryville, 
Va. ; cured in the spring of 1849. 

Case 101. George B. Webster, Esq., aged 50, merchant, 
Buffalo, JSTew York ; cured in the summer of 1849. 

Case 102. Samuel Alexander, aged 45, farmer, near Har- 
rodsburg, Ky. ; cured in the summer of 1849. 

Case 103. J. D. Powers, Cincinnati, Ohio ; cured in the 
fall of 1849 ; previously treated by Dr. T. Y. Morrow. 

Case 104. Jenison H. Piatt, aged 32, farmer, near Mt. 
Yernon, Ind. ; cured in the fall of 1849. 

Case 105. Hon. H. S. Horton, aged 45, merchant, Pom- 
eroy, Ohio; cured in the fall of 1849. My friend, Mr. H., 
was for many years a Senator in the State Legislature of 
Ohio. 

Case 106. Joseph Alden, Esq., aged 40, Louisville, Ky. ; 
cured in the fall of 1849. 

Case 107. John B. Smith, aged 40, planter, near Thibo- 
dauxville, La. ; cured in the spring of 1850. 

Case 108. Eben Wiatt, aged 34, cab-driver, New Orleans ; 
cured in the spring of 1850. 

Case 109. William E. Criglar, aged 32, lumber-merchant, 
Milton, Florida ; cured in the spring of 1850. 

Case 110. Dr. Williamson, planter, Assumption, La. ; 



FISTULA IN ANO. 163 

cured in the summer of 1850. Dr. W. had previously been 
operated on with the knife. 

Case 111. J. L. Thielan, Esq., aged 53, cashier in the 
Sheriff's office, New Orleans, cured in the spring of 1850. 
My friend, Mr. T., had both fistula ani and piles. 

Case 112. A. G. Mayers, aged 38, Fort Smith, Arkas. ; 
cured in the summer of 1850. Mr. M. had a most extraor- 
dinary large fistula in ano. 

Case 113. Col. J. A. Stockton, Wheeling, Ya. ; cured 
in the spring of 1850. 

Case 114. Daniel Scott, farmer, near Milton, Ky. ; cured 
in the spring of 1850. 

Case 115. H. "W". Cood, Esq., aged 28, lumber merchant, 
Louisville, Ky. ; cured in the summer of 1850. 

Case 116. Edward Slaughter, aged 3, son of George W. 
Slaughter, hardware merchant, Louisville, Ky. ; cured in the 
summer of 1850. This manly little fellow's fistula ani was 
upwards of a year's standing. 

Case 117. William K. Webster, aged 19, Brooklyn, K Y. ; 
cured in the summer of 1850. 

Case 118. Thomas Davidge, aged 39, ship rigger, Pitts- 
burg, Pa. ; cured in the summer of 1850. 

Case 119. John Frisel, aged 41, moulder, Pittsburg, Pa. ; 
cured in the summer of 1850. 

Case 120. W. H. Harlan, aged 26, Cincinnati, Ohio ; 
cured in the summer of 1850. 

Case 121. T. E. Kerchival, pilot, St. Louis, Mo. ; cured 
in the summer of 1850. 

Case 122. B. R. McKennie, Esq., aged 44, editor of the 
" Nashville True Whig ; " cured in the summer of 1850. My 
friend Mr. McK. had both piles and fistula. 

Case 123. J. F. Dowdall, St. Louis, Mo. ; cured in the 
summer of 1850. 



164: fistula m ANO. 

Case 124. Captain Lewis Snapp, New Orleans ; cured in 
the summer of 1850. 

Case 125. Dr. Thomas Gale, aged 50, planter, Nashville, 
Tenn. ; cured in the fall of 1850. My friend Dr. G. had 
quite an extensive fistula in ano. 

Case 126. Chelium Moore, aged 26, farmer, Benton's Port, 
Iowa ; cured in the fall of 1850. 

Case 127. Lieut. J. H. Spotts, U. S. Navy ; cured in the 
fall of 1850. Mr. S. had previously been operated on with 
the knife, in the navy hospital, at Norfolk, Ya. 

Case 128. Andrew Eichey, aged 41, farmer, near Pitts- 
burg, Pa. ; cured in the fall of 1850. 

Case 129. William Forgay, Esq., 159 Clinton street, New 
York, was cured in the fall of 1850. My friend Mr. F. had 
quite an extensive fistula ani. 

Case 130. James A. Gaither, aged 27, lawyer, New 
Orleans ; cured in the spring of 1851. 

Case 131. John F. Fisler, farmer, Dudley Town, Ind. ; 
cured in the summer of 1851. 

Case 132. Jacob S. Aber, aged 40, Linn, Mass. ; cured in 
the summer of 1851. My friend Mr. A. had previously been 
treated by Dr. B. L. Hill, of Cincinnati, Ohio, by Dr. Beach's 
method. 

Case 133. William A. Stuart, Esq., aged 42, Columbia, 
S. C. ; cured in the summer of 1851. 

Case 134. Isaac W. Hutchison, merchant, Harrodsburg, 
Ky. ; cured in the fall of 1851. 

Case 135. Asa Howell, aged 56, farmer, Corcicana, Texas ; 
cured in the winter of 1852. 

Case 136. L. G. Philips, Esq., Assumption, La. ; cured in 
the winter of 1852. 

Case 137. George W. Bishop, merchant, Cincinnati, O. ; 
cured in the winter of 1852. 

Case 138. R L. Kay, Esq., aged 38, merchant, Memphis, 



' FISTULA IN ANO. 165 

Term. ; cured in the winter of 1852. My friend Mr. K. had 
both fistula in ano and piles. 

Case 139. W. J. Darden, aged 35, overseer, Donaldson- 
ville, La. ; cured in the spring of 1852. Mr. D. had been 
previously operated on with the knife. 

Case 140. Hon. E. Hickman, Mayor of Memphis, Tenn. ; 
cured in the spring of 1852. Mr. H. now resides in San 
Antonio, Texas. 

Case 141. John F. Bast, tobacconist, Louisville, Ky. ; cured 
in the summer of 1852. 

Case 142. Thomas H. Fowler, aged 21, clerk ; cured in the 
summer of 1852. 

Case 143. James H. Parker, Esq., merchant, Columbia, 
Mo. ; cured in the fall of 1852. 

Case 144. L. C. Adkins, aged 28, Natchez, Miss. ; cured 
in the fall of 1852. 

Case 145. J. A. Flood, aged 27, New Orleans ; cured in 
the fall of 1852. 

Case 146. Richard Lancaster, aged 34, Harrodsburg, Ky. ; 
cured in the fall of 1852. 

Case 147. Rev. Robert Hysell, Pomeroy, Ohio ; cured in 
the fall of 1852. 

Case 148. Benj. Bresback, aged 26, farmer, near Circle- 
ville, Ohio ; cured in the fall of 1852. Mr. B. had been pre- 
viously operated on with the knife. 

Case 149. Joseph McCreight, aged 38, coachmaker, Louis- 
ville, Ky. ; cured in the fall of 1852. 

Case 150. Wilson D. Stilley, aged 29, farmer, Marion, 
Illinois; cured in the winter of 1852. 

Case 151. Thomas B. Lee, Esq., New Orleans ; cured in 
the spring of 1853. 

Case 152. Dr. Lewis Williams, Philadelphia, Pa. ; cured 
in the spring of 1853. 



166 FISTULA IN ANO. 

Case 153. E. S. Hunter, jun'r., merchant, Milwaukee, 
Wis. ; cured in the spring of 1853. 

Case 154. E. J. Miller, Esq., merchant, Cincinnati, Ohio ; 
cured in the spring of 1853. 

Case 155. David Adams, farmer, near Harrodsburg, Ky. ; 
cured in the summer of 1853. 

Case 156. John H. McNeal, farmer, near Columbia, Mo. ; 
cured in the summer of 1853. 

Case 157. Captain John W. Sketo, aged 46, Little Rock, 
Ark. ; • cured in the summer of 1853. 

Case 158. Dana Jemison, ,aged 25, clerk, Covington, Ky. ; 
cured in the summer of 1853. 

Case 159. Loyd Campbell, farmer, near New Cumberland, 
Ya. ; cured in the fall of 1853. 

Case 160. John P. Blan gy, aged 35, Cincinnati, Ohio ; 
cured in the fall of 1853. Mr. B. had previously been oper- 
ated on with the knife. 

Case 161. T. C. Woods, aged 31, merchant, Barboursville, 
Ky. ; cured in the fall of 1853. 

Case 162. Isaac N. Marks, Esq., merchant, New Orleans ; 
cured in the winter of 1854. 

Case 163. John K. Kearney, aged 25, planter, Vernon, 
Miss. ; cured in the spring of 1854. Mr. K. had a very exten- 
sive fistula ani, and had been operated on several times with 
the knife, in New York, the previous summer. 

Case 164. P. Oscar Ayraud, planter, Ascension, La. ; 
cured in the spring of 1854. My friend Mr. A. had a very 
large fistula in ano. 

Case 165. John T. Jacob, merchant, Circleville, Ohio ; 
cured in the summer of 1854. 

Case 166. Frederick Blackman, New York; cured in the 
spring of 1854, in New Orleans. 

Case 167. James Logan, aged 35, feed store, Lafayette, 
La. : cured in the winter of 1 852. 



FISTULA IN ANO. 167 

Case 168. M. M. Caleb, Esq. ; agent American Transpor- 
tation Company, New York ; cured in the summer of 1854. 

Case 169. Anson Baldwin, Esq., Yonkers, 1ST. Y. ; cured 
in the summer of 1854. 

Colored Persons Cured of Fistula in Ano. 

The following list comprises a few of the most inveterate 
cases of fistula in ano which I cured in colored persons : 

Case 1. George, aged 45, farmer ; cured in the summer 
of 1841. George was owned by Samuel "Wallace, Esq., near 
Midway, Ky. 

Case 2. Sam, aged 21, spinner ; cured in the summer of 
1842. Belonged to Horace Coleman, of Fayette Co., Ky., 
and worked in the hemp factory of Henry Clay, Jr., of Lex- 
ington, Ky. 

Case 3. Bill, aged 38, farmer ; cured in the fall of 1844. 
Belonged to George Parker, Esq., near Paris, Ky. 

Case 4. Thomas, aged 35 ; cured in the summer of 1846. 
Tom belonged to Dr. Strother, of Bardstown, Ky. 

Case 5. Isham, aged 40, blacksmith ; cured in the fall of 
1848. Isham was a most valuable man, and belonged to 
George J. Rowland, Esq., Louisville, Ky. 

Case 6. George, aged 45, farmer ; cured in the summer 
of 1849. The property of G. B. Bates, Esq., near Louis- 
ville, Ky. 

Case 7. Julia, (a mulatto) aged 30 ; cured in the spring 
of 1850. Belonged to H. B. Kennar, ISTew Orleans. 

Case 8. Sol Patterson, (free) aged 44, shoemaker, Louis- 
ville, Ky. ; cured in the summer of 1850. 

Case 9. Mose, aged 45 ; cured in the fall of 1850. The 
property of Benj. J. Adams, Esq., Louisville, Ky. 

Case 10. Jake, aged 15 ; cured in the summer of 1851. 
Belonged to G. B. Bates, Esq., near Louisville, Ky. 



168 



ABSCESS NEAR THE RECTUM AND ANUS. 



Case 11. Henry, aged 38 ; cured in the summer of 1851. 
Belonged to William S: Scott, Esq., New Orleans. 

Case 12. James, aged 37 ; cured in the summer of 1852. 
Belonged to Arthur Wallace, Esq., Louisville, Ky. 

Case 13. Beverly, aged 35, farmer ; cured in the fall of 
1852. Belonged to T. Et. Wallace, Esq., of Marion, Ky. 

Case 14. Harrison, aged 28, farmer ; cured in the sum- 
mer of 1853. Belonged to Major James Harris, near Colum- 
bia, Mo. 

Case 15. Henry, aged 26, farmer ; cured in the summer 
of 1853. Belonged to P. Chamberlain, Esq., near Louis- 
ville, Ky. 

Case 16. Malaki, aged 50, farmer ; cured in the summer 
of 1841. Belonged to James Hiter, Esq., New Liberty, Ky. 

Case 17. Madison, (free) aged 31, hack-driver ; cured in 
the fall of 1850— Harrodsburg, Ky. 



CHAPTEE Yin. 



ABSCESS NEAR THE RECTUM AND ANUS. 



In the preceding chapter, much has been anticipated in 
relation to this kind of abscess. I have there shown that it 
precedes fistula, and that the latter is a consequent of the 
former. The reason that this chapter does not precede that 
on fistula, as it naturally should do, is in consequence of my 
not treating as many cases of simple abscess, as I do of fistula. 
Patients do not, at this stage of the disease, invoke surgical 
aid, as they by all means should do, but defer it until the ab 
scess becomes fistulous. Hence, in the arrangement of this 
work, I have placed it where it is. 

The vicinity of the rectum and anus is very subject to 



ABSCESS NEAR THE RECTUM AND ANUS. 169 

various kinds of purulent collections, in consequence of the 
abundance of free cellular tissue by which it is invested. 
This tissue, it is well known, is very liable to suppuration, 
especially in this region, where the slightest inflammations 
sometimes result in it. This is not surprising, when we take 
into consideration its dependent situation, its exposure to 
compression, to contusion, to accumulations of blood, and to 
numerous other causes. 

These abscesses are of various kinds, and may be either 
independent of disease of the rectum and anus, or be pro- 
duced by a morbid condition of these organs. I will not, in 
this work, adopt the division of them into numerous kinds, 
as some authors do, but simply include all under a few sim- 
ple heads. 

The commencement of an acute phlegmonous abscess of 
the rectum or anus, may be known to the patient, by 
increased heat and pain of the parts, followed by a swelling, 
and by a throbbing sensation, which renders him indisposed 
to motion, or compels him to remain at rest, by rendering 
every movement of the parts, as well as the lower extremi- 
ties, distressing. On examination, if the abscess is about to 
point externally, an enlargement, or tumefaction, a circum- 
scribed hardness, can be seen and felt, There is great intol- 
erance of pressure, and sometimes a blush, more or less livid, 
of inflammatory redness of the parts. Sometimes there is a 
constant desire to urinate, and a difficulty in voiding urine. 
In a few days, matter forms, and is discharged externally by 
one or more openings. After which, the pain and inflam- 
mation cease. When the abscess points internally, the anal 
canal becomes diminished in size by the swelling, which im- 
poses a mechanical impediment to the passage of the fasces, 
and renders defecation excessively painful. Constipation of 
the bowels, and a great dread of stooling, usually attend such 
cases. The irritation extends to the bladder and urethra, 



170 ABSCESS NEAR THE RECTUM AND ANUS. 

and the discharge of urine is attended with difficulty — some- 
times impossible. If the finger be introduced into the anus, 
a round tumor is detected at a greater or less distance from 
the orifice, encroaching upon the canal ; it is often as large 
as a nutmeg, or larger ; well defined, hard, or exhibiting 
signs of fluctuation, according to the stage of the complaint ; 
and almost always confined to one side of the bowel. In a 
short time, the tumor breaks into the bowel, and finally 
causes an internal blind fistula. These kind of abscesses are 
usually rapid in their progress. Fatigue, deterioration of 
health, and insufficient nourishment, dispose to this form of 
them, and in some instances, seem sufficient for their pro- 
duction ; while contusions, sitting on wet seats, and riding on 
horseback, may also be causes of them. 

The chronic abscesses of these parts are usually attended 
with irritative fever. They are generally large, deep-seated, 
and accompanied with a sense of weight, occasional throb- 
bing, and spasm of the sphincter muscle. The swelling, 
though not very great externally, is, however, very percepti- 
ble to the finger, if introduced into the bowel. The urinary 
organs sympathize, but do not to the same extent, as in the 
acute form just described. These abscesses are slow to burst ; 
they usually open externally, but sometimes they open into 
the rectum. They sometimes come on almost imperceptibly, 
the cellular tissue and the skin being much less extensively 
diseased, and not attended with fever and local suffering. 

The gangrenous species of abscess, differ very much from 
fhe last described ; they are usually more extensive. They 
appear to be various in their mode of attack, and in the ra- 
pidity of their progress. The patient first complains of deep- 
seated pain, by the side of the anus, where a hard point 
may be easily detected, which soon spreads ; then the pain 
assumes a burning character, there is considerable tenesmus, 
and great difficulty in discharging urine. All these symp- 



ABSCESS NEAR THE EECTU3I AND ANUS. 171 

toins are much more severe than in any of the other forms 
of abscess. The swelling becomes diffused, the tension 
increases, though not to a very considerable extent, and the 
skin turns livid. Finally, partial openings arise from the 
mortification of the integuments, and the pus, with portions 
of cellular tissue, are discharged very slowly. I once saw a 
case where there was complete sloughing of the parts all 
round, leaving the anus and the lower portion of the rectum 
quite bare. This form of abscess occurs in bad constitu- 
tions, especially in such as have lived free and luxuriously, 
and are advanced in life. 

The critical abscesses of this region, occur after fevers, 
and repelled eruptions. They usually resemble the other 
forms of abscess. They sometimes occur in children after 
eruptive diseases, one or two cases of which I have met in 
my practice. In those cases they had become fistulous. 

The symptomatic abscesses are those which arise in other 
organs, and extend downwards by the side of the anus; and 
those which arise from sympathy with the lungs. The first 
include spinal, urinary and uterine abscesses. The second 
occur in those who labor under consumption, of which I 
will speak in the next chapter. In diseases of the spine, 
uterus, or urinary organs, or in the soft parts of their imme- 
diate vicinity, the collections of matter may work their way 
downward, until they appear at the side of the anus, without 
producing any pain, inflammation, or hardness of the sur- 
rounding parts. I have treated a number of such kind of 
abscesses, some desperate and of long standing. About five 
years ago, I cured Mr. Boone Montgomery, of Decatur, 
Ohio, of a spinal abscess of long standing. His spine was 
injured by a fall from a horse. He had submitted to various 
treatment without benefit. About the same time I cured 
Mr. O. P. Evans, of Clark Co., Ky., of a spinal abscess, for 
which he had previously submitted to three operations with 



172 ABSCESS NEAR THE RECTUM AND ANUS. 

the knife. The following letters from him will be explana- 
tory of his ease. 

Winchester, Ky. y April 20, 1840. 

Dear Doctor : — About two years ago, I was affected, as I thought, with 
a bile on the lower end of the spine, which first appeared in the form of a 
lump as large as the end of my thumb ; and continued some six months, 
coming and going. At last it broke and run, and continued to discharge 
for some time • it then healed up, and remained about two months ; but 
one day, as I was riding on horseback, it broke again, and run for several 

months. I applied to Dr. , who pronounced it a fistulous abscess, and 

said he could cure it by operating on it with the knife, to which I consented. 
But the operation did not succeed ; so that he was compelled to operate the 

second time, without any better success. I then applied to Dr. , who 

also operated on me, and it appeared to heal up, but it was only on the out- 
side ; as it always pained me about the scar and the surrounding parts, 
until it broke again. There are now three openings, through' which are 
discharged a thin yellow water, sometimes a bloody water. There is ano- 
ther abscess forming in the same neighborhood ; it is like a bile, and has 
been coming for eight or ten days. 

The old abscess is about three inches long, and my physicians have told 
me that it does not enter into my bowel, but up the back bone, which they 
say is much diseased. It has never been very painful, only when about to 
rise. It was caused by a fall from a horse. I have never been well since. 

This gentleman I subsequently cured, and as far as known 

to me, he still remains well. 

Dr. Bodenhamer : — My Dear Sir — I am just in receipt of your invalua- 
ble work on Anal and Rectal Diseases, for which please accept my warmest 
thanks. I see, on the 63d page, that you have published my first letter to 
you, and at the conclusion you remark, that the individual still remained 
well, to the best of your knowledge. I can truly say, that I was thoroughly 
cured when I left you, and have remained entirely well to this day — now 
about six years. And I can also say, that had it not been for your skill 
and your peculiar method of practice — which, in my opinion, cannot be 
surpassed in this or any other country — I might still have labored under 
this wretched disease. Please accept my very best wishes for your future 
good health and prosperity. 

I am very respectfully, yours, 

0. P. Evans. 
Winchester, Ky. y June 3, 1847. 

In the spring of 1845, 1 cured the Kev. Mr. Elliott, a Catho- 
lic clergyman, of Fairfield, Ky., of a spinal abscess of fifteen 



ABSCESS NEAR THE RECTUM AND ANUS. 173 

years' standing. He had previously been once operated on 
with the knife. His spine was injured by his being thrown 
from his carriage. The following- is an extract from a letter 
from him, dated Fairfield, Ky., January 2, 1847. 

Dear Doctor : — It was with the greatest pleasure that I received and 
perused your work on diseases of the Rectum, Anus, &c. It is in my 
estimation well calculated to benefit a great portion of our fellow beings, 
were it generally circulated among them. It gives full and satisfactory 
descriptions of the diseases under which so many labor for years, either 
because they have a delicacy in making them known, or because the 
remedy prescribed by their physicians seems more painful to them than 
the disease itself. 

The display alone of the surgeon's knife, and other butchering instru- 
ments, is sufficient so cause the stoutest heart to shudder. I can readily 
conceive how a man's pride and ambition may excite him to what the 
world calls an honorable settlement of difficulties, or enter into the battle- 
field ; but how any one can quietly and coolly suffer another to cut and dig 
through flesh, nerves, blood-vessels, and even into his very bowels, and 
that too at the peril of his life, is almost inconceivable. In the first case, 
passion blinds and makes a brute of the man ; but in the latter, man uses 
deliberately all that distinguishes him from the brute, and quietly submits 
to a torture which is more sensibly felt than any that was ever experienced 
in the field of battle. 

The world should ever be grateful to the man, who, guided by Divine 
goodness, has discovered a means of relieving humanity of its evils without 
inflicting pain. For I can say, with a truth, that during the seven weeks 
treatment I received at your hands, I suffered nothing — for what I felt did 
not deserve the appellation of pain ; and rather than again submit to the 
operation of the knife, I would prefer your treatment even for seven years. 

When making my first visit to you, I fell in company with a very emi- 
nent surgeon of , to whom I communicated the object of my visit to 

Louisville. He dissuaded me from applying to you, and one of his princi- 
pal reasons was, that it required at least eight or ten weeks to effect a 
cure, when the knife would do it in as many days. I observed that 
this was rather a recommendation than an objection — for I thought that 
old diseases were similar to old habits : there is danger in a sudden cure, 
and consequently I should prefer the weeks to the days ; and I have never 
regretted my choice. 

Ky—July 30, 1841. 

Dear Doctor : — My sister has consented to employ you, instead of Dr. 
D . We will visit you in eight or ten days. She despairs of ever be- 



174 ABSCESS NEAR THE RECTUM AND ANUS. 

ing cured, having, as you know, been twice operated on by the knife, by 
two able surgeons of Philadelphia. The last cut extended along the spine 
at least four inches, and down to the bone, which was actually scraped, as 
it was thought the bone was much diseased. I askecj her particularly, since 
I saw you, with regard to the cause \ she cannot assign any whatever. 

This young lady I cured some five months after the date 
of the ahove letter. She soon regained her general health, 
and subsequently married. She was of a scrofulous diathesis. 

About sixteen years ago, I cured a negro man belonging 
to Mr. McDewitt, of Shelby county, Ky., of one of the 
largest abscesses I ever saw. It was caused by caries of the 
ischium, (hip-bone). One sinus extended from the hip down 
to the knee. This poor fellow had previously been operated 
on by an. eminent physician of Louisville. Four or five 
deep and extensive incisions were made, two extending high 
up into the rectum. 

In the summer of 1850, I cured Mr. Ephraim Jones, of 
Pittsburg, Pa., of a spinal abscess of eleven years standing. 
I also in the fall of the same year cured Mr. Joseph C. Al- 
len, (of Harrodsburg, Ky., but now of Henderson, Ky.) of a 
spinal abscess. All the cases above named remain well to 
the present time, 1855. 

Stercoraceous abscesses, are such as have either a primary 
or secondary communication with the intestinal canal, into 
which, portions of faecal matter enter. Not long since, I 
opened an abscess at the side of the anus, partaking some- 
what of this character. It had no direct communication with 
the intestine ; yet the matter discharged, was of a brownish 
color, and had the peculiar odor of faeces. This can only be 
explained upon the principle, that all collections of fluids in 
the vicinity of the rectum, will imbibe the odor, as well as 
the color, of the fsecal matter, by iransjiiration, which is now 
well known to take place through all animal membranes. M. 
Yelpeau lays particular stress on this fact. The patient was 
a lady in very delicate health. 



ABSCESS NEAR THE RECTUM AND ANUS. 175 

Traumatic abscesses are induced by the passage of balls, 
punctures ; the irritation produced by the presence of a for- 
eign body — incisions in lithotomy, &c. 

M. Ribes relates the case of a lieutenant, " who received a 
musket ball in the centre of the right buttock, which frac- 
tured the tuber ischii, and passed into the rectum, as proved 
by the immediate flow of blood from the anus, and the exit 
of the ball on the sixteenth day, by the same outlet. The 
external wound suppurated freely, and in six weeks had 
healed ; but the right side of the peringeum inflamed, and 
seemed, from its bluish appearance, about to become gan- 
grenous, so as to lead Eibes to suspect stercoraceous abscess. 
However, he punctured it, but could not detect any opening 
in the rectum. On the contrary, he found that the walls of 
this bowel were much thickened. In a few days he extri- 
cated a fragment of bone and some pieces of cloth, after 
which the abscess healed. I once saw," continues Dr. 
Bushe, " a case not unlike this, in a soldier who was wounded 
in India. The bone, however, was not injured ; but the ball 
passed into the rectum, and was ejected from the anus. The 
wound in the intestine healed, while the cutaneous one 
remained fistulous, until I extracted two pieces of cloth from 
it, several months afterwards." 

Punctured wounds may produce abscesses in this situation. 
I have seen but one such case, and it was in a porter, who 
had sustained the injury in climbing a spiked railing. I have 
seen but one case, in which a stercoraceous abscess resulted 
from the presence of a foreign body, and this was in the per- 
son of a boy, eleven years old, who swallowed, between three 
and four months previously, a portion of the thigh bone of a 
chicken, about half an inch long. He had suffered severely 
before I was called ; but the nature of his complaint was not 
suspected. I laid the parts freely open, and extracted the 
bone. There are several interesting cases of this kind on 



176 ABSCESS. NEAR THE RECTUM AND ANUS. 

record, of which the following are the most remarkable. Le 
Dran relates a case which occurred to M. Destendau, of a 
man, who for nine months labored under a fistula, caused by 
the lodgment of a piece of bone. Petit mentions some cases 
of this kind. In one, he extracted a needle, which for six 
months, had given rise to extraordinary pain, during defeca- 
tion. In a second, he removed a small triangular bone, which 
for four or five months, had created great suffering. In a 
third, there was extensive mortification of the parts surround- 
ing the anus, in consequence of the lodgment of a chicken 
bone, after a year's duration. Finally, in a fourth, he opened 
an abscess, which contained fgecal matter and shot. The dis- 
ease was of ten years standing. Stalpart Yander-Yiel relates 
a case of a man who swallowed the jaw of a fish, and seven 
months afterwards, had it extracted from an abscess near the 
anus. Sherman mentions a case, in which a fish bone was 
swallowed, and discharged twelve months afterwards from an 
abscess by the side of the anus. Harrison describes a case 
of abscess which resulted from the retention of an apple core, 
eight months after it was taken into the stomach. M. de la 
Payronie extracted a beef bone, M. Febvrier removed a 
pullet bone, and M. Dubois, a piece of an earthenware pot, 
from stercoraceous abscesses." (Bushe on Diseases of the 
Rectum and Anus, pp. 237-8.) 

Mr. Green tells of a case in which the pelvis of a snipe 
was removed from a large anal abscess. 

These examples should be a warning to persons to beware 
of what they swallow. 



CHAPTEE IX. 

Complication of Anal Abscess, or Fistula Ani, with 
Phthisis Pttlmonalis. 

That there is a connexion between pulmonary disease and 
anal abscess, or fistula ani, is a point as well established, per- 
haps, as any other in pathology ; yet, by many it is denied, 
or considered extremely difficult to trace, or of a highly mys- 
terious character. The many cases, however, that have 
come under my observation, have fully satisfied me, not only 
of such connexion, but that it may be satisfactorily explained. 
It is well known that there is a large amount of the cellular 
membrane investing the lower extremity of the rectum ; that 
this tissue, in this vicinity, has a large number of veins ; that 
these in the last stages of phthisis, can have but little adven- 
titious support, in consequence of the absorption of fat — the 
emaciation of such cases being strongly marked in the adi- 
pose cellular membrane and muscles. Tubercular deposi- 
tions, in the lungs too, must, in a greater or less degree, inter- 
fere with the return of the blood from the veins ; and the 
constant impulse communicated to the anal region by cough- 
ing, must also greatly tend to the production of these 
abscesses. From these considerations, and from the prone- 
ness to suppuration in the cellular tissue, we can at once 
account for the frequent occurrence and concurrence of 
these diseases, with pulmonary affections. They are associ- 
ated with phthisis in two different ways — first, as a contem- 
poraneous, but independent accident, and secondly, as a con- 
sequence. 



178 COMPLICATION OF ANAL ABSCESS WITH PHTHISIS. 

Laennec has seldom seen phthisis complicated with fistula, 
and when it does exist, he does not believe that it exerts any 
influence over it. He says, " It is a common opinion, 
strengthened by the adoption of it by Bordeu, that phthisical 
subjects are particularly liable to fistula in ano, which helps 
to protract the termination of the disease. I have seldom 
observed this complication, and where it existed, it has 
appeared to exert no influence over the progress of the case." 
(Zaennec on Diseases of the Chest, p. 294.) Andral has come 
to the same conclusion. He says that he has met with only 
one instance of fistula in ano, in about eight hundred cases 
of phthisis. (Clinique Medicate tome, IV., jp. 307.) 

The celebrated M. Louis is also of the same opinion. 
{Researches on Phthisis, <&c, Translated oy Walshe.) Dr. 
Clark also states that although he has often met with this 
affection, {fistula ani,) he has not been able to trace any con- 
nection between it and phthisis, further than its probable 
dependence on abdominal plethora, which so frequently pre- 
cedes the latter malady. (Clark on Consumption, p. 163.) 

The following communication on this subject, is from my 
friend, the late and lamented Dr. McDowell, formerly of 
Louisville, Ky., who during his life, treated more cases of 
consumption, than any other physician in the Mississippi 
valley, with the exception of my friend Dr. W. W. Hall, the 
able editor of " HalVs Journal of Health" New York. 

Evansville, la., October 3d, 1851. 

Doctor Bodenhamer — Dear Sir : Yours of the 29th ult., relative to 
complications of fistula in ano with phthisis, was duly received. That the 
complication is frequent, and that the fistula exerts a salutary influence 
over the phthisis, I believe is the general impression of the medical pro- 
fession. Yet I am not able to furnish you any valuable personal experi- 
ence on the subject — never having met with the complication but twice in 
the whole course of thirty-two years practice. In one of these, both dis- 
eases were cured — the fistula first — in the other, both continued unto the 
death. Yet the well known irregularity of the bowels, in phthisis, the 
relaxing influence of diarrhoea, and the alternate irritation of constipation, 



COMPLICATION OF ANAL ABSCESS WITH PHTHISIS. 179 

would seem necessarily to conduce more than ordinarily, to anal ulcera- 
tion; but the idea of any beneficial influence from this, or from any other 
intestinal irritation, in the treatment of a disease in which so much depends 
on the condition of the digestive functions as phthisis does, is unexplained, 
and I think inexplicable. If the revulsive influence of a counter-irritant 
were necessary, I should prefer to establish it upon any other part of the 
body. 

I am much pleased to learn that you contemplate the publication of a 
practical work on a class of diseases — the rectum and anus — in the treat- 
ment of which you have been so eminently successful, and am sorry I am 
able to afford you no more than the above, inconclusive contribution. 

Very respectfully. Wm. A. McDowell. 

As it is my intention to enter most fully into this subject, 
in my large forthcoming work on diseases of the Anus and 
Rectum, I will merely state here, that, in eight hundred and 
fifty-nine patients, some laboring under Anal Abscess, and 
others under Fistula in Ano, that came under my immediate 
notice during the last seventeen years, forty-six had con- 
firmed consumption. The great practical point, however, is 
not whether there is an intimate connection between anal 
abscess or fistula in ano, and phthisis pulmonalis ; or whether 
these diseases are frequently found together in the same 
patient ; but it is whether the anal abscess, or the fistula in 
ano should be cured, when either one or the other is found to 
be present in a phthisical patient. This is the important 
question. 

A very popular opinion prevails, both in and out of the 
profession, that it is improper to attempt the cure of abscess 
or fistula, in persons laboring under phthisis, or in those in 
whom there exists a strong disposition to it ; believing that 
such a disease acts beneficially on the lungs, operating as a 
sort of derivative remedy, &c. This, to a great extent, is a 
fatal error, and has proved so in numerous instances. As a 
general rule, these diseases tend greatly to aggravate the pul- 
monary affection, by impairing, as they always do, the con- 
stitutional powers ; therefore, the sooner they are cured the 



180 COMPLICATION OF ANAL ABSCESS WITH PHTHISIS. 

better. I readily admit, that to attempt to cure them with 
the knife, would be highly improper, and would hasten the 
patient to the grave ; and it was doubtless in reference to 
this operation alone, that this opinion was first founded, and 
not to proper and judicious treatment. It is true, that in all 
cases where anal abscesses appear in the very last stage of 
phthisis, when all hope of the patient's recovery is gone, it 
would be improper as well as useless, to attempt their cure, 
if it ever could be done. I have seen such cases apparently 
benefited on the first appearance of an anal abscess ; they 
were unexpectedly, as it were, restored to better health ; and 
their pulmonary disease became quiescent for the time 
being, but the improvement proved not to be permanent ; it 
did not last long ; the discharge from the abscess either dried 
up or continued, and the patients sooner or later sunk. The 
patient should, however, under all circumstances, have by 
all means the advantage which a proper and judicious treat- 
ment offers, recollecting that an anal abscess, or a fistula ani, 
may more frequently be the primary cause of consumption, 
than the cure of it. I have yet to see the first bad results 
from attempts at curing those diseases in such patients by my 
method ; it has never been productive of any injury, but on 
the contrary, in producing the most happy results. Indeed, 
according to my method, no harm can result in attempting 
to cure such cases, even if it should not prove successful ; 
but this cannot be said of the knife, which is always pre-emi- 
nently fatal in such cases. If I should find my patient get- 
ting worse under my treatment, I can at once stop ; this can- 
not be done when the knife is used. I repeat, that according 
to my method, no harm can result ; for if nature finds herself 
relieved or benefited by a discharge of this kind, she will 
generally continue it, in spite of the most officious endeavors 
to the contrary. 

About three years ago, I cured Mr. John C. Evans, a 



COMPLICATION OF ANAL ABSCESS WITH PHTHISIS. 181 

respectable gentleman of Louisville, Ky., of a fistulous 
abscess at the side of the anus, which he had previously- 
labored under for several months. It was complicated with 
a serious disease of the chest, and pronounced consumption 
by the best physicians of Louisville. He was very much 
emaciated, had violent cough, profuse expectoration, together 
with night sweats, and hectic fever. All the physicians 
whom he consulted, advised him not to have any thing done 
for his fistula ; stating, that if that was cured, it would only 
accelerate his pulmonary affection, and hasten his death. He 
consulted me ; I gave him an opinion directly the reverse of 
this. He however, at that time, still continued to take the 
advice of his physicians. Three months after this I saw him 
again, very much worse, and despairing of ever being cured. 
He however determined to take my advice, and submit to 
treatment. In about eight weeks I cured him of his abscess, 
and almost entirely relieved him of his cough, and all other 
bad symptoms. In nine months, his general health was 
entirely restored, and now, he is one among our most hearty, 
stout and hale citizens'. This is but one case out of numerous 
others of a similar character that I might give. I have 
received and continue to receive, many letters similar to the 

following : 

LETTER I. 

N , Ind., Feb. 26, 1840. 

Dr. Bodenhamer : Dear Sir — In December, 1837, I was attacked with 
a most dreadful cough, and pain in my side, something like inflammation 
of the lungs. I immediately called on a physician who attended me for 
several months, but did me very little good. I then called in another, who 
soon got me out of bed, so that I was enabled to attend to business again. 
But I never got entirely relieved of my cough. About eight months ago, 
a tumor formed at the side of my bowel, which was very painful for several 
days, until I had it lanced. Tt discharged almost a pint of matter, and has 
continued to discharge ever since. Lately, my cough has got much worse, 
I have chronic diarrhoea, night sweats, and acid stomach constantly. I 
spit up a large quantity of the worst looking corruption, and it looks 
exactly like the matter which comes from my fistula. My physician has 



182 COMPLICATION OF AISTAL ABSCESS WITH PHTHISIS. 

never done any thing for this sore, telling me that if I have that cured, 1 
would die of consumption. I am becoming very uneasy about it, as I 
believe if I was cured of it, I would get well of my other diseases. I am 
now scarcely able to walk about. What do you think ? Do you think it 
would do to have this fistula cured or not ? Please write immediately, and 
if you think that it should be cured, I will visit you immediately. 1 forgot 
to tell you that I am. forty years old; and that whenever I touch the 
fistula, it brings on a spell of coughing. 

I cured this gentlemen three months after the date of his 
letter, and two years afterwards, when I heard from him, he 
was entirely well. 

LETTER II. 

M , Ky n June 16, 1842. 

Dr. Bodenhamer : Sir — I take the liberty of asking your opinion of my 
case. I am laboring under a disease of my lungs, which commenced a year 
ago. 1 spent last winter in New Orleans, and while there, was attacked 
with a fistula in ano, for the cure of which you are no doubt very justly 
celebrated. A large tumor formed at the side of the bowel, and broke, and 
has been discharging ever since. Now, doctor, do you think that curing 
the fistula would interfere with the restoration of my lungs to a healthy 
state, which my physician says they are gradually attaining ? He advises 
that the fistula should be let alone until my lungs are restored ; but I am 
fearful that in this he is mistaken, as the fistula is a great annoyance to 
me, and I am certain that it weakens me much. I saw your friend, Mr. F., 
the other day, whom you cured a few years since. He gave me much 
encouragement, telling me that when he first called on you. he was in 
every respect as bad as I am. 

This gentleman was prevailed on by his physician not to 
submit to treatment for his fistula, that he was getting well, 
&c. In about two months after the date of the above, he 
died. 

Whilst at New Orleans, last winter, a young gentleman 
consulted me (the first of February, 1846,) for a fistula, com- 
plicated with a slight affection of the lungs. I advised him 
not to delay the cure of his fistula a day, as it was evidently 
the cause of his other affection, and very much aggravated 
it. The slightest touch of the probe about the sinus, would 



FISSURE OF THE ANUS. 183 

excite coughing. He told rcie that he was compelled to 
attend to his business for a month or two, before he could 
submit to treatment ; but that he would see me at Louisville 
about the first of May. He called on me the first of June, but 
he had emaciated so, that I could not recognize him. I 
advised him to return home as soon as possible ; that I could 
not do any thing for him, and that it was impossible for him 
to live but for a short time. He thanked me kindly for my 
candor, and told me he seriously regretted the folly of his 
course, in not taking my advice at New Orleans. He died 
in three weeks after this interview. Persons should never 
defer a day, the treatment of such diseases, as they are so 
liable to terminate in consumption, or some other serious 
organic disease. A very large number of cases of this kind 
could be given. 



CHAPTER X. 

Fissure of the Anus. 



This disease was so called by Boyer. It appears to be a 
very common affection in France, as all the French surgeons 
speak of it, and it is to them chiefly, that we are indebted for 
what has been written on the subject. It is a very painful 
disease, very difficult to treat successfully, and very liable to 
be overlooked, without a very minute examination, and it is 
not uncommon in our own country. 

Description of Fissure of the Anus, 

This most painful and distressing disease consists in a 
superficial ulcer, about the eighth of an inch wide, and from a 
quarter to an inch in length, located within the anal canal, 



184 FISSUEE OF THE ANUS. 

and most commonly on one or both sides. It is, however, 
sometimes found on the posterior, as well as the anterior part 
of the anal orifice. The ulcer is generally superficial and 
confined to the mucous membrane ; but it sometimes extends 
to the muscular tissue. When the disease is recent, the edges 
of the ulcer are soft and pliant ; but as it becomes chronic, 
they become hard and elevated. The appearance of the 
ulcer is generally a bright red ; but sometimes it is grayish. 
It bears a strong resemblance to the cracks or chaps which 
so often exist in the hands, feet, or corners of the mouth. Its 
situation may be perceived, as it is generally low down, by 
simply separating the converging folds of the marginal skin, 
and gently drawing down the rectum. (Yide Plate III., fig. 
2.) "When the disease is some distance up the canal, the 
speculum arri will have to be used to bring the sore into view. 
It is said that females are more subject to this disease than 
males, which may be accounted for by the neglect with which 
the former generally treat the state of their bowels, consti- 
pation being a powerfully predisposing cause. It is, how- 
ever, common to both sexes, and generally occurs in the 
meridian of life. I have, however, seen it several times in 
quite young children. 

Some of the Causes of Fissure of the Anus. 

This disease is often caused by hemorrhoidal tumors or 
excrescences, and when this is the case, the ulcer will gener- 
ally be found between two of them. A very common cause 
is laceration of the mucous membrane of the anal canal, by 
expelling hardened fgeces, the edges of the rent or crevice do 
not unite and heal, but become hard and elevated, and thus 
form a fissure. Laceration from the awkward manner of 
introducing instruments into the anus, such as the pipe of 
the enema syringe, &c, is also sometimes a cause. For 



FISSURE OF THE ANUS. 185 

other causes of this disease, see the chapters on Pruritus of 
the Anus, and Excrescences of the Anus. 

The Symptoms of Anal Msswe. 

The intense suffering which this disease occasions, is greatly 
disproportioned to the extent of the ulcer. Indeed the great 
distress which is experienced, and the nervous anxiety which 
is manifested, even by firm-minded persons, are often sur- 
prising when the small amount of the local malady is con- 
sidered. 

I have noticed that flatulent distention of the stomach and 
bowels to be often a prominent symptom in this disease, 
together with other sympathetic affections. The essential 
symptoms, however, of the disease, are a burning pain and 
sometimes a contraction of the sphincter ani muscles. In 
the early stages of the disease, the pain is not severe, 
amounting to nothing more than a pricking, stinging, or 
smarting sensation, at a certain point in the anus. But as the 
disease advances, the pain gradually increases, and becomes 
excessive. " The pain is, according to M. Merat, sometimes 
paroxysmal, which he attributes to the presence of accumu- 
lated fseces pressing on the sphincter. At its greatest height, 
this complaint is, says Yelpeau, accompanied by horrible 
suffering. The patients compare the pain they feel at the 
moment of an evacuation, to that which would be produced 
by the passage of a red hot bar. This sensation of burning, 
is sometimes so severe as to produce an inexpressible 
anguish, with threatenings of convulsions or syncope. 
Others say it seems as if something was tearing in the funda- 
ment. In the intervals, between the stools, there sometimes 
remain only smarting or lancinating pains, more or less 
severe — a sensation of weight, and some griping. On the 
approach of defecation, on the contrary, the pains become 
obviously augmented. They do not acquire their greatest 



186 FISSURE OF THE ANUS. 

violence until the moment of the expulsion of the faeces, and 
go on decreasing for some hours. The constipation becomes 
so obstinate, that the alvine evacuations take place but once 
in eight, ten and twelve days, if they are not promoted by 
art. The patients having an incredible dread of going to 
stool, postpone the moment as long as possible, although they 
are aware that they suffer more by the delay. Some patients 
think themselves under the necessity of taking purgatives on 
alternate days. A woman treated by M. Boyer, resorted to 
the use of a canula, which she fixed in the anus. A patient 
at the Hotel Dieu, insisted that he would prefer death to the 
necessity of going again to stool. Although some persons 
are able to walk, sit, or occupy many hours in employment 
during the intervals between their attacks, others are obliged 
to remain in bed, although they suffer cruelly with the heat 
and fatigue. In certain cases, the lancinating pains shooting 
towards the bladder or the uterus, according to the sex, 
extend even to the greater part of the hypogastrium. Diges- 
tion is disturbed. From the fear of evacuations, the patient 
eats but little, and he loses his natural color. His features 
soon begin to express the sufferings he endures — so that one 
might believe that he labored under some profound organic 
lesion. Spitting, coughing, or even singing ; in short, all 
sudden, or rather strong efforts of the lungs, sometimes 
aggravate the pain. {American Cyclopedia of Practical 
Medicine and Surgery, Vol. II, Art. Anus, p. 118.) 

When the fseces are solid, they are sometimes streaked 
with blood and matter. The introduction of the finger into 
the anus, is attended with great difficulty and torture ; some- 
times producing the most violent spasms of the sphincter 
muscle. The existence of the disease may often be detected 
by the mere touch of the finger alone. As soon as the finger 
comes in contact with the fissure, the most violent pain will 
be experienced by the patient, and a hard wrinkled chord will 



FISSURE OF THE ANUS. • 187 

be felt, which will indicate the precise situation of the crack. 
Pus, as well as blood, is often discharged in small quantities 
from fissure of the anus. The sufferings of females who labor 
under this disease, are greatly increased by the presence of 
the catamenia. " There is one symptom," says Dr. Colles, 
" that will better explain the nature of this case, than even 
an examination through the rectum — and it is so constant 
and so obvious, that I wonder very much it has escaped 
writers on the subject — it is, that there is always a distinct 
interval of time, from ten minutes to an hour or more, between 
the passage of faeces and the occurrence of the pain." (Lec- 
tures, p. 279.) 

"There is sometimes," says Dr. Syme, "a small firm red 
colored pile, like a pea in size and form, at the base or out- 
ward extremity of the fissure, which tends not only to con- 
ceal the sore, but to render its exposure more painful. To a 
practiced eye, indeed, the peculiar form, consistence, and 
color of this little swelling, render it a good guide to the seat 
of annoyance ; but it more frequently misleads to the idea that 
there is no local complaint, or only an external hemorrhoid." 
(On Diseases of the Rectum, p. 126. JEclinburg, 1854.) 

Popular Method of Treating Anal Fissure. 

The popular method of treating this disease, is by dividing 
both sphincter muscles through the fissure, with the knife. 
This operation is described by Dr. Bushe, as follows : " The 
patient should be placed opposite a window, couched on his 
side ; an assistant ought to separate the buttocks, and retain 
them so during the operation. The surgeon having oiled the 
fore-finger of his left hand, inserts it into the anus, as far as 
the second joint, and uses it as a conductor for the knife, 
having a blade two inches long and one-eighth broad, with a 
blunt extremity. Having passed the blade flatwise, as high 
as the superior border of the internal sphincter, he then turns 



188 FISSURE OF THE ANUS. 

its edge towards the fissure, provided it be on the side of the 
bowel, and divides both sphincters, by cutting from within 
outwards, gradually increasing the pressure, so as to insure 
the complete section of the external muscle. Provided a 
fissure exists on the opposite side, it ought to be treated in 
the same manner." {On Diseases of the Rectum, dbc.^p. 105.) 

This outrageous and unnecessary operation was first per- 
formed and recommended by Boyer. Its advocates recom- 
mend it upon the principle that spasm or contraction of the 
sphincter ani muscles is the chief cause of the fissure, and 
consequently of the pain ; hence it is said to be an infallible 
remedy. It is by no means true that spasm or contraction of 
the sphincter muscle is the cause of the fissure, or even that 
it is present in every case, as I have had abundant evidence 
in my practice. As to its being an infallible remedy, the 
idea is simply ridiculous. I have known it to fail in many 
instances, even after having been repeated several times. 
Every surgeon is aware that this operation is attended with 
danger. The wound which results, always suppurates for 
some time, and may occasion dangerous accidents. The 
inflammation and formation of matter may extend to the pel- 
vis, and compromise the patient's life. 

For further objections to this repulsive and formidable 
operation, see the chapter on Fistula in Ano. 

A less objectionable operation for anal fissure has of late 
been recommended by Blandin, which consists in the sub- 
cutaneous division of the sphincter ani muscle. 

According to my method of treating this serious disease, 
there is no necessity whatever, for any painful or dangerous 
operation. I have demonstrated this, in the successful treat- 
ment of thirty-one cases of this disease, within the last ten 
years. 

Two^years ago, (1844,) I cured Samuel P. Weisiger, Esq., 
a highly respectable gentleman of Louisville, Ky., of a fissure 



FISSURE OF THE ANUS. 189 

of the anus, complicated with an internal blind fistula and 
haemorrhoids. This gentleman, for several months previous 
to consulting me, had suffered the most violent agony from 
this complication of diseases. Within this time, he had sub- 
mitted to medical and surgical treatment, having had one or 
two external pile tumors removed, without any benefit what- 
ever. The main disease having been mistaken for haemor- 
rhoids, was entirely overlooked by his medical attendant. 
Such was Mr. "W.'s suffering, that after having an evacuation 
from his bowels in the morning, he was compelled to remain 
on his couch all day ; and the only time that he could be up 
and attend to business at all, was in the morning, an hour or 
two before stooling. This gentleman's diseases were doubt- 
less caused by obstinate constipation of the bowels. He was 
cured without dividing the sphincter muscles, in five or six 
weeks, by a method neither painful nor hazardous. He con- 
tinues well to the present time — now, 1855. 

Letters from Persons Afflicted with Anal Fissure. 

LETTER I. 

, %., September 10, 1841. 

Dear Sir — My wife is af&icted with a serious disease of the lower 
bowel, for which she has taken much medicine from several physicians, 
without any permanent good effect. Indeed, they do not appear to under- 
stand her disease. Her physicians all have advised her to consult Dr. 

D , believing that some surgical operation will be necessary. We have 

come to the conclusion before taking this step, to consult you, (in opposi- 
tion to all the physicians in this section,) and if you think you can cure 
her. we will visit you as soon as we get your answer to this. For several 
years, my wife labored under costive bowels, for the relief of which she 
was compelled from time to time, to take purgative medicine. About seven 
months ago, one day after she had taken a large dose of Cook's pills, 
which operated severely, she was taken with such a burning pain, while at 
stool, that she nearly fainted. Ever since, whenever she stools, and for 
hours after, she suffers the most agonizing pain. These pains extend to 
her back, and down her lower extremities, and sometimes so affect her 
bladder, that she cannot urinate without great difficulty. Her discharges 



190 FISSUKE OF THE ANUS. 

from her bowels are frequently mixed with mucus, blood, and matter, and 
when she has these discharges, the burning is just like hot lead passing 
down her bowels, as she describes it. She is nearly all the time confined to 
her bed, a mere skeleton, and so nervous, at times, that we can scarcely do 
any thing with her. Such is the dread she has of an operation on her 
bowels, that she frequently sheds tears for an hour or two previous. She 
has no cough, and her digestion is good, and if she was relieved of this hor- 
rid disease, she, I think, would be well. Some of her physicians call her 
disease fistula : others piles. She has had three children, the youngest two 
years old, and her age is thirty. 

This lady was cured by me six months after the date of the 
above letter, and she is now in the enjoyment of excellent 
health. I found, upon examination, a fissure on each side of 
the anus, one extending up the canal about one inch ; the 
other was about half an inch long. 

LETTER II. 

C . 0, June 5, 1844. 

Dear Sir — Having heard that you have been remarkably successful in 
treating diseases of the bowels, I have taken the liberty of writing you. I 
have been suffering almost martyrdom, for the last year, from a most trou- 
blesome and distressing affection of my lower bowel. I experience the 
greatest suffering while I am stooling, and then it is often so severe, that I 
am compelled to lie down for several hours. At these times, the burning 
and smarting are so severe, that it appears to me it could not be any worse 
if a red hot iron was run into the bowel. I have such a horror of stooling, 
that I only have a passage every other day, at night, so that I do not lose 
so much time in the day, by lying down. I use Blue Lick water to keep 
my bowels loose. The sore place is on the right side of the anus, commu- 
nicating low down, and extending up about an inch. I can feel it quite 
distinctly with my finger, the introduction of which, however, causes the 
most intense pain. The only discharge I have noticed from the place, is a 
little matter streaked with blood. I have no doubt but this disease was 
caused by obstinate constipation of the bowels, under which I labored for 
years, and for which I have taken large quantities of purgative medicines. 

The disease did not come on suddenly, but gradually. T am thirty-one 
years of age, my health good in other respects, and I am by profession a 
lawyer. You will now doubtless wonder what I did for my disease. I 
have done every thing. I have consulted the best medical men. and they 
all have disagreed with regard to my disease, some calling it piles, some 
ulceration, and some fistula in ano. About six months ago, I submitted to 



FISSURE OF THE ANUS. 191 

the operation of laying all the parts open with the knife, by Dr. , of 



. This operation afforded me partial relief for about six weeks; but 

I am now as bad as ever. I have lost all hope, and almost despair of ever 
being cured. I would much rather be dead than be compelled to live in 
this condition. Can you cure me ? Can you give me any relief? 

I am happy to say that I cured this gentleman about three 
months after the date of his intelligent letter. I found, upon 
examination, a fissure about a quarter of an inch wide, 
extending up the canal nearly an inch. It could nearly all 
be brought to view, by causing him to strain. The division 
of the sphincter muscles, to which he had submitted, was not 
through the fissure, but in the immediate vicinity. The cut 
was but partially healed when he consulted me. 

In the spring of 1850 I cured Col. J. Woolfolk, of Wood- 
ford County, Ky., of this most distressing disease. I treated 
my friend, the Colonel, in New Orleans. He remains well 
to the present, 1855. 

In the spring of 1852 I cured Mr. John Devereaux, a mer- 
chant of New Orleans of an anal fissure of long standing. 

In the winter of 1853 I cured Lafayette Folger, Esq., iron 
merchant, of New Orleans, of this disease. My friend, Mr. 
F., had for some time been treated by two or three physi- 
cians, who had mistaken the nature of his disease. His 
sufferings were intense. His cure was complete, and he 
remains well to the present time, 1855. 

I have successfully treated a very large number of 
females for Anal Fissure. 



CHAPTEE XL 
Prolapsus of the Rectum. 

This is a very troublesome, very disagreeable, and often 
a very serious accident. Indeed, there are few diseases that 
are more painful and distressing to bear. I shall distinguish 
it into two varieties, which are generally confounded. First, 
into that which is most common — in which there is a simple 
relaxation and protrusion of the mucous membrane alone of 
the rectum, which passes through the sphincters, in conse- 
quence of either their too great relaxation, or their paraly- 
sis. (Yide Plate V., Fig. 1.) Second, into that which is less 
common, in which there is an inversion as well as a pro- 
trusion outwards of the rectum, including both mucous 
membrane and muscular tunic ; or, in other words, in which 
the whole gut protrudes. (Yide Plate Y., Fig. 2, also plate 
VI.) Most authors term this disease " Prolapsus Ani / " but 
as the anus is simply the aperture into the rectum, and is a 
firmly fixed point, it cannot therefore be prolapsed. 

In the first variety, the mucous membrane alone is 
everted in the form of a ring, and may project from one to 
two inches from the margin of the anus ; in the second 
variety, it comes down in the shape of a globular or oblong 
mass, and may project from one to four inches. 

This disease occurs most frequently in children and per- 
sons advanced in life. 

The following are some of the principal causes of this 
affection : — Too much standing on the feet ; long-oontinued 



LA TL V 




a . Uie Membrane protruded, 
b. the Splimcler iVfiiscJo.evxTrLcd. 



He/ 2 






mi 




a. Uic 73 owe I protruded 



PROLAPSUS OF THE RECTUM. 193. 

straining efforts at stool in the sitting posture. This is a 
common cause, and all persons having a tendency to pro- 
lapsus recti should always have their stools either standing, 
lying, or sitting on a chair, so high as to prevent their feet 
from reaching the ground ; their bowels should never be 
evacuated in any other posture, as either of these positions 
will keep the trunk erect, and moderate the force of the 
expulsive efforts. The usual sitting posture renders the 
pressure of the diaphragm most direct upon the contents of 
the pelvis, and thus favors the descent of the bowel. Con- 
stipation of the bowels is a common cause, as it requires 
protracted straining to expel the hard fasces ; all drastic 
purgatives, such as aloes, &c. ; colic ; prolapsus uteri ; par- 
turition ; stricture of the urethra; stone in the bladder; 
violent coughing; sneezing; enlargement of the prostate 
gland ; hemorrhoidal tumors ; ascarides (worms) which 
nestle in the rectum, are a common cause, especially in chil- 
dren. When the disease depends upon a want of contrac- 
tion of the sphincter muscles, the causes generally are, dis- 
eases, or injury of the brain, or spinal chord ; exhaustion, 
attending weak health ; sedentary habits ; protracted dis- 
eases ; operations performed for fistula ani ; for fissure ; for 
stone in 'the bladder. When this disease takes place in aged 
persons, it is owing to a general relaxation of the tissues, and 
the imperfect tone of the sphincters. Children are more 
liable to this disease than adults, owing to the intestine being 
less curved, and to the imperfect development of some of 
the contiguous organs to the intestine, which, when perfect, 
give strength and support to it ; and from the fact that they 
suffer much from irritation of the mucous membrane. 

When this affection first appears, it usually presents but a 
small tumor, surrounding the anus, like a ring. This gene- 
rally takes place by the efforts at stool, and it returns slowly 

of itself, when those efforts cease. Sometimes it comes 
13 



194: PEOLAPSUS OF THE RECTUM. 

down after a costive motion only, and either goes up of 
itself, or is easily pushed up, and when up, remains in its 
place until some accidental circumstance brings it down, 
such as constipation again ; diarrhoea ; and, in children, 
severe fits of crying. But, if it is not checked in time, it 
increases in size, and appears at every stool, and no longer 
returns of itself, but has with difficulty to be replaced. 
"When it arrives at this stage, in many cases, as soon as the 
protrusion is returned, it comes down again on the slightest 
movement, such as standing, walking, riding, and sometimes 
the least excitement will cause it to fall down. Such per- 
sons are generally miserable, for they can neither cough, 
sneeze, nor laugh, without its coming down; neither are 
they by any means able to keep it up entirely, at any time, 
as a small portion always remains out. In cases of long 
standing, the protruded portion becomes so fixed in its 
unnatural position, that it cannot be returned, and then it 
becomes inflamed from friction, ulcerated, sore, tender, 
painful, and finally covered with a kind of cuticle. 

In some cases, when the j^rotrusion remains out any length 
of time, it becomes engorged with blood, from the pressure 
which the sphincter exercises on the veins, as manifested by 
its increase in size, and livid color. If it is not soon reduced, 
inflammation takes place, attended with great local pain and 
fever ; and in some instances, death ensues in consequence 
of extensive peritoneal inflammation. In some very rare cases, 
the protrusion sloughs off, and a natural cure follows. 

This disease should not be confounded with internal 
haemorrhoids. This is a common error, and committed even 
by those who should know better. Nothing, however, is 
more absurd or more unscientific. The distinction is impor- 
tant, and should never be lost sight of. The difference is 
this — when internal piles protrude, that portion only of the 
mucous membrane to which they are attached, or which 



PEOLAPSUS OF THE RECTUM. 195 

covers them, comes down, or is pressed down, as indeed it 
necessarily must ; whereas in real prolapsus of the second 
variety, the mucous membrane, as well as the muscular tunic, 
protrudes for several inches. In the former, then, the mucous 
membrane descends, without the muscular tunic, and only 
that portion of it too, to which the piles are attached, and no 
more. 

It may also be confounded with intussusception of the 
bowel. In prolapsus, neither the probe nor the finger can be 
introduced higher up than the border of the internal sphinc- 
ter muscle, in consequence of the doubling down of the 
mucous membrane ; while in intussusception no resistance is 
offered to the ascent of either one or the other. 

The popular method of treating this disease, when the case 
is very bad, is excision of the whole dependent flap ; or in 
other words, the removal of the whole natural lining mem- 
brane of the middle and lower portions of the anal canal. 
Sometimes only a few of the folds of the prolapsed portion 
are dipt off with the scissors. Sometimes the actual cautery 
is used, as well as caustic of various kinds. I reject all of 
these, and my success in the treatment of this disease is the 
best commentary on the excellence of my method, and proves 
to a demonstration, that those violent and dangerous measures 
are not by any means necessary — for I have treated success- 
fully some as bad cases as are on record. 

LETTER A. 

E , Ky n May 1, 1843. 

Dr. Bodenhamer — Sir : I see from a card in the Louisville Journal, 
that you treat diseases of the rectum, anus, &c. I have been sorely afflicted 
with a falling down of the bowel, or as you surgeons call it, prolapsus of 
the rectum, for fifteen years. For the last six years, I am confined most 
all the time to my couch, as I cannot take the least exercise without the 
parts coming down. I can neither stand nor walk ; for sometimes, as soon 
as I stand up, down it comes, and on some occasions this even takes place 
in bed, by violent coughing, spells of which I sometimes have. The pro- 



196 PROLAPSUS OF THE RECTUM. 

traded parts are as large as my fist, or the largest size apple. It has become 
hard and rough, and at times a little yellow water runs from it. I am 
quite well in other respects. I am sixty-five years old. I had determined 
to visit Philadelphia about the middle of this month, in order to have my 
disease operated upon, and wish you to answer this immediately, as I shall 
be governed in this matter by your letter. Let me know whether you can 
cure me, or whether I can be cured at all by any method. I have already 
tried every thing I could hear of, after consulting numerous physicians. 

This gentleman I cured sometime after the date of the 
above, as the following letter will show. 

LETTER B. 

E -, Ky., November 3, 1843. 

Dear Doctor — I arrived home in safety on the first of October, and I 
am still free from my old disease. I have tried it effectually by riding, 
walking, and even by running. I believe I am entirely well. I follow 
strictly the rules you laid down to prevent a return of the disease. I con- 
sider them of the greatest importance, and I am well convinced that if 
they were closely followed by those who have the disease, that they alone 
would in nearly every instance effect a cure. 

I have just cured, April 15th, 1855, Mr. Miguel Ousso, a 
Spaniard, aged 61, residing in the parish of Ascension, La., 
of a prolapsus of the rectum, of many years standing. This 
was the worst case of the kind I ever saw — the protrusion 
being almost constant, and as large as the largest size Creole 
orange, resembling somewhat Figure II. Plate Y., though 
destitute of the concentric rings which are represented in 
that figure. 

The late S. Mackenzie, M. D., of London, reports the fol- 
lowing extraordinary case of prolapsus of the rectum of the 
second variety or form : — 

" A lady in the country," says Dr. Mackenzie, " sent for 
me to attend her, in April, 1834. She briefly stated her case 
by letter ; but its representation was of such an extraor- 
dinary character, that I could scarcely credit the possibility 
of its existence. On my arrival, however, I was soon unde- 




PLATE Vi: 



a.'tho'Rovre! jjrolmdci. 
b. the SphincLerl/lnscle. 



PROLAPSUS OF THE RECTUM. 197 

ceived, by being shown a prolapsus of the gut, which came 
down with an evacuation, six inches in length, and eight 
inches in circumference at the base, tapering off gradually to 
about six inches in circumference at the extremity. It 
appeared in a perfectly healthy condition, but became very 
tender on exposure to the air. (Yide Plate YI.) The domes- 
tic in attendance returned the prolapsus in my presence with 
great skill and dexterity. The sympathy which this amiable 
and afflicted lady excited in my mind at the narration of her 
sufferings, induced me to remain two days in attempting to 
afford her relief, by preventing the gut from falling at the 
time of evacuation ; but all my mechanical contrivances 
proved unavailing. 

" To give any thing like a narrative of this melancholy case, 
would occupy every page of my publication. I have only, 
therefore, room to state that, for nearly five years, this lady 
has never risen from a horizontal position, and upon the 
least attempt to place her feet upon the ground, a tremor 
immediately pervades the whole muscular and nervous sys- 
tem, and renders the effort impracticable." {On Piles and 
Prolapsus, dec, p. 71. London, 1835.) 



CHAPTEE XII. 
Ulceration of the Kecttjm. 

Feom whatever cause ulceration of the rectum may be 
induced, it not unfrequently produces severe suffering, and 
sometimes proves very unmanageable. 

The causes of this disease are various. It may be induced 
by the passage of hardened faeces, in obstinate constipation, 
which occasions great friction upon the mucous membrane ; 
by the careless employment of surgical instruments, which 
may produce lacerations or abrasions ; by surgical operations 
on the rectum ; by the passage of foreign bodies taken into 
the stomach ;by the entanglement of faeces in the mucous 
follicles, and their consequent enlargement ; by the contact 
of venereal virus ; by unusual and rapid distension of the 
rectum ; by chronic inflammation of the mucous membrane. 
It is often a consequence of chronic diarrhoea or of chronic 
dysentery ; and in children it is sometimes complicated with 
thrush ; it is frequently associated with tubercular disease of 
the lungs or the liver. 

Ulcers of the rectum are sometimes found in irregular 
patches of a fungoid appearance, and of a livid, or dark red 
color, slightly elevated above the surrounding parts on the 
mucous membrance (Yide Plate VII. Fig. 1.) ; again, they 
are small, well defined, and with quite elevated edges; and 
again, in old cases, they may be found excavated, with jagged 
and livid edges, devoid of granulations, covered with an 
ash-colored tenacious matter, and surrounded by a deep 



PLATE VJJ 




f a, A ring to tiaii g :d Ir 
b. Orifice oitlie Jiasc^ 
c.lTiellose . 
d.Stqp Cock 
e.ATad lo prevent Ike 
xetarni ofQuiil . 
irfiectatnlipe . 



A porkou olHTic rectum laid open 




a. Jiiteritfti surface of ijiexectimi 
1» Dicers of tfe rectum . 



ULCERATION" OF THE RECTUM. 199 

inflammatory blush. When the ulcers are situated in the 
anal canal, within the limits of the sphincters, they are 
exquisitely painful, like fissure of the anus. They sometimes 
spread rapidly, attacking many points of the rectum, and 
extend up high. Such cases usually terminate fatally, espe- 
cially in bad constitutions. 

By the introduction of the finger, the ulcerated surface may 
very easily be detected, by its roughness ; and when it is low 
down, nothing more will be necessary than to separate the 
buttocks, and evert the edges of the anus with the fingers. 
The best method, however, is to dilate the anus with a good 
speculum ; then the situation, the extent, the form, and the 
character of the disease, can at once be easily determined. 
The lower portion of the colon and the rectum are more lia- 
.ble to ulceration, than any other portion of the alimentary 
canal, doubtless in part owing to the accumulation and reten- 
tion of fseces in this region. The feculent matter being 
detained here, becomes foetid and putrid, either from imper- 
fect digestion or long retention, or from both ; thus it be- 
comes a source of irritation, inflammation, and ultimately, 
ulceration. 

Not unfrequently, the coats of the rectum are thickened 
at the parts where these ulcers are situated, and in some 
'instances, this thickening is so great as to diminish the area 
of the rectum considerably, and in this way finally produce 
stricture. 

"With regard to venereal ulceration of the rectum, it may 
arise from the direct application of venereal virus, or it may 
be consecutive to disease in the genital organs, and then 
co-exist with other secondary symptoms. When it is caused 
by the direct application of the poison, it usually begins 
around the anus, passing up into the rectum, and extending 
up even to the colon. Where these ulcers heal, the whole 
circumference is occupied by chaps or clefts, indicative of 



200 ULCERATION OF THE RECTUM. 

the former existence of those ulcers, called "Bhagades," 
caused by venereal virus. The whole surface of the rectum 
as high as the promontory of the sacrum, is often rough and 
hard, from the cicatrization of the ulcers. The muscular 
coat is thickened and indurated, and by this means, the 
diameter of the bowel, as in other kinds of ulceration, is con- 
siderably lessened. This kind of ulcerative process goes on 
progressively from the anus upwards, those healing below, 
while new ones are forming above. Their sensibility is not 
very great, except those around the anus. Sometimes in 
these cases, the mucous coat of the rectum, is the eighth of 
an inch thick, and so much indurated, as to resemble gristle. 

This chronic thickening and chronic ulceration, may last, 
in some cases, for a long time. 

The symptoms of this disease are, acute pain and smart- 
ing in the rectum ; especially while at stool ; pain in the 
back, extending to the loins ; irritation of the bladder ; flatu- 
lent colic in the umbilical region ; a sense of weight in the 
rectum ; tenesmus ; a discharge of thin bloody foetid pus 
from the rectum, amounting from a teaspoonful to a half 
pint, at each evacuation. The discharge, in some cases, is 
going on all the time ; in others it ceases frequently for a 
few days, then comes on profusely again. These discharges 
are sometimes very offensive ; they either precede or follow 
the stool, and are scarcely ever mixed with it, unless the 
ulceration extends high up ; when the fseces are hard they 
are all besmeared with it. When the ulceration is low 
down, the symptoms resemble those of fissure of the anus ; 
such as spasm of the sphincters, &c. 

" Ulceration of the rectum," says Dr. Bushe, " is difficult 
to heal : firstly, because from the absence of valves in the 
portal system, and the depending situation of the hsemor- 
rhoidal veins, they are loaded with blood, a condition which 
is still further increased by the accumulation of faeces in the 



ULCERATION" OF THE RECTUM. 201 

lower bowels, and the action of the sphincters: secondly, 
because the passage of the faeces contuses, and stretches the 
ulcerated surface : thirdly, because if the ulceration be 
within the limits of the sphincter, it is not only unduly com- 
pressed, but puckered : fourthly, because the plicated condi- 
tion of the mucous membrane, and the action of the sphinc- 
ters, prevent the proper adjustment of suitable applications ; 
and fifthly, because we are unable to make pressure, a most 
efficient remedy in similar diseases of other parts." 

LETTER I. 

W , Ky.j Nov. 3, 1840. 

L ear Sir — My daughter, who is thirteen years old, has some serious dis- 
ease of her bowels. About two years ago. she had measles, and soon after 
she was attacked with diarrhoea, which still continues, but not near as bad 
as it used to be. About six months since, she commenced discharging small 
quantities of matter and blood mixed ; attended with pain in the bowel, 
especially when stooling. This continues gradually to increase in quan- 
tity, and she now passes about half a pint in twenty-four hours ; some- 
times it looks like pure matter, at other times it appears like bloody water, 
and it now is very offensive to the smell. Her health has been good hith- 
erto, but she appears now to be wearing away gradually, and her abdomen 
is swelling, and quite hard. She has the most voracious appetite, and 
wishes to eat any thing. 

This was a case of extensive ulceration of the rectum, as I 
found, upon examination. I cured her. 

LETTER II. 

G , Miss., Aug. 25, 1841. 

Dr. Bodenhamer — Dear Sir: Last winter I took a violent cold from 
exposure, crossing the mountains in the stage from Philadelphia. Ever 
since I have been unwell. A short time after I came home, I frequently 
had considerable pain whenever I had to stool, and I noticed that I dis- 
charged a little matter and mucus, mixed with blood, somewhat like the 
flux. I now suffer the most terrible pain sometimes, when I stool, espe- 
cially when I take medicine. When my stools are moderately soft, I do 
not suffer so much pain. My bowels are very costive, and when I have a 
hard stool, the stool is completely covered with matter. I am fearful that 
I am about having a stricture of the bowel, as lately I cannot have a hard 



202 ULCERATION OF THE RECTUM. 

stool, as I formerly had, and it appears to me the parts are growing up. I 
can feel the sore about two inches up the bowel. It feels hard and rough. 
I have found but little relief from my physician, and feel anxious to visit 
you, if you think my case comes under your practice. 

This gentleman visited me a short time after the date of 
his letter, and upon examination, I found four or five ulcers 
on the mucous membrane of the rectum ; they were each 
about the size of a picayune. Under my treatment, he 
recovered rapidly. 

LETTER III. 

La. } September 1, 1845. 
Dear Doctor — I am glad to hear that you are going to New Orleans 
this winter, as I will be saved the trouble of visiting you at Louisville. 
My physician tells me that I have ulceration of the lower bowel. I pass a 
great deal of matter from my bowel daily, without much pain, however. 
He has done me no good so far. 

This gentleman I cured at New Orleans. 



CHAPTER XIII. 

Inflammation and Excoriation of the Anus. 

In consequence of the exquisite sensibility with which the 
skin about the margin and adjacent parts of the anus is 
endowed, it from various causes, is very liable to irritation, 
inflammation, or excoriation. 

These affections are generally associated, and may be 
induced by the following causes : — By the unavoidable attri- 
tion of the parts, in walking or riding long distances ; by the 
passage of irritating secretions ; by gross want of cleanliness 
of the parts ; by obesity and warm weather ; by luxurious 
living ; by an entanglement of the hairs by which the parts 
are clothed, or by the removal of the hair by the patient or 
surgeon. M. Velpeau mentions the case of a physician who 
removed the hair with scissors, and in whom such violent 
pain and fever followed, that he was compelled to keep his 
bed for three days. " The hair," says Dr. Coates, " in this, 
as in many other situations, is intended to prevent the con- 
tact' of the sides of the nates, and to act like a friction wheel 
in machinery, to diminish the attrition. For this reason, it 
is much more abundant in the male sex, because the anus is 
much more deeply situated in man. To remove it entirely, 
would therefore, produce no slight inconvenience; but when 
cut short, or when after being shaved, it has again grown to 
a certain length, it acts like a harsh brush upon the delicate 
skin, and may produce very severe inflammation." 

In bad cases of these affections, the cuticle is sometimes 



204 INFLAMMATION AND EXCORIATION OF THE ANUS. 

abraded, and a sero-purulent discharge oozes out from the 
naked cutis, which becomes indurated, and a circumscribed 
blush of inflammation surrounds it. These complaints will 
generally yield to habits of perfect cleanliness, aided with 
daily ablutions of cold water — to moderation in diet — to the 
avoidan ce of all stimulating applications, and to the use of 
raw cotton, dry lint or linen, so as to absorb all moisture and 
prevent attrition from the clothing. 

Corpulent persons are more liable to these affections than 
the lean ; and gross livers than temperate ones. They are 
quite common among a certain class of the poor in large 
cities, caused by filthiness of the parts. In such persons, 
these affections sometimes become serious, and then they will 
consult a physician, who will find that the injunction of 
cleanliness, is of all things the most difficult to be enforced. 
He will find it much easier to cure the disease, than to cure 
the cause of it. 

These affections should always be attended to in time, as 
they always, if not cured, result in ulceration, in abscess, or 
in some other disease in this situation. 



CHAPTEK XIY. 
Pruritus of the Anus. 

This is a most distressing and rebellious affection, lasting 
for months, years, and even for life, and by some considered 
incurable — frequently reappearing after having been appa- 
rently cured. It is peculiar to no sex or occupation, though 
it appears more common in males than in females, and in old 
age, than in adult life. 

The causes of this troublesome disease are somewhat 
obscure. It seems, however, to be nearly always connected 
with a disordered state of the mucous membrane of the ali- 
mentary canal. Sometimes it appears to depend upon a 
morbid state of the alvine secretions, which is often con- 
nected with general debility, especially in those who follow 
sedentary occupations. It most often occurs in weak consti- 
tutions, in old people, and in females who have ceased to 
menstruate. Ascarides in the rectum, and hemorrhoidal 
tumors often give rise to it. Strong mental emotions are 
also a frequent cause. The eruption is characterized by dis- 
tinct papules, usually of the same color of the skin, accom- 
panied by itching. This itching is sometimes intolerable, 
and the patient, in his attempts to relieve himself by scratch- 
ing, takes off the top of the papule, and causes abrasions of 
the skin, which are followed by an oozing out of an irritating 
serous fluid, which produces excoriations of the parts. Patches 
of a similar eruption to those around the anus, are often 
developed upon the scrotum, upon the root of the penis, upon 



206 PEUEITUS OF THE ANUS. 

the inside of the thighs. These are sometimes continuous with 
that on the anus, upon the back, upon the neck, upon the 
groin, upon the labia pudendi, &c. From the repeated rub- 
bing and scratching to relieve this intolerable pruritus, chro- 
nic inflammation is excited in the parts, and the skin around 
the anus becomes thickened and furrowed, and the elemen- 
tary form of the disease is lost. 

The itching generally comes on towards evening ; but it 
becomes intolerable when the skin is excited by the warmth 
of the bed, and not unfrequently prevents sleep for several 
hours. Stimulating drinks of all kinds, as well as all stimu- 
lating food, are the most exciting causes. 

This disease prevails to a great extent in some of the 
Southern States. Indeed I believe in those States, every 
fifth or sixth person is annoyed with it to a greater or less 
degree. 

Many physicians, after exhausting the materia medica in 
endeavoring to cure this disease, have come to the conclusion 
that it ought not to be cured — but kept as a kind of safety 
valve ; that the cure would be attended with imminent danger, 
&c. " The late Dr. Lettsome," says Dr. Bushe, " thought 
that the pruriginous state of the anus, prevented the occur- 
rence of more serious diseases. He formed this opinion from 
having seen persons, after various long indispositions, relieved 
by it. A gentleman, sixty years of age, who had been sub- 
ject to pectoral disease, was perfectly cured by the appear- 
ance of this pruriginous affection. A favorable termination 
of the same kind occurred in a case threatening apoplexy. 
Another patient was relieved from the gout, in a similar- 
manner. He, however, imprudently endeavored to allay the 
itching by the application of a strong saturnine lotion, which 
produced the desired effect ; but after a few days, he sud- 
denly expired." • 

It is of the highest importance in the treatment of this 



EXCRESCENCES OF THE ANUS. 207 

obstinate, troublesome, and rebellious disease, in the first 
place, to detect, and well understand the cause whicb produ- 
ces it. 

I have been remarkably successful in the treatment of this 
affection, and could here give the names of a large number 
of individuals whom I have cured, some three, four, and six 
years ago, and who remain well to this day. 



CHAPTEE XT. 

Excrescences of the Anus. 



The Anus and its vicinity are very liable to a great 
variety of vegetations and excrescences, such as scirrhus, 
candyloma, steatoma varix, &c, none of which, however, 
are absolutely peculiar to this region. They usually sprout 
out from the fine skin and mucous membrane, about the 
verge of the anus. They are sometimes very numerous and 
varied in their form, in consequence of which, the Greek, 
Latin and Arabic authors have designated them by many 
fanciful appellations. They possess scarcely any vitality, 
and consequently endowed with but little sensibility. They 
generally are smooth, soft, and fragile; they sometimes, 
however, are rough, hard, and furrowed on their surface. 
They are usually the color of the skin or mucous membrane, 
from which they sprout ; they are however, sometimes of a 
dark, as well as of a pale red color, and usually of small 
size. They sometimes exist alone, at other times they are 
associated with pile tumors ; and there is constantly a puru- 
lent discharge from them. 

The cause of these singular productions is somewhat 
obscure. Some have attributed them entirely to venereal 
virus ; but this is an error. Dr. Bushe says that " Some 
authors look upon these excrescences as arising, in every 



208 EXCRESCENCES OF THE ANUS. 

instance from the syphilitic poison. This opinion, however, 
is not tenable ; for the fact is, that they existed, as we have 
undoubted testimony, when syphilis was unknown. In the 
authors now alluded to, we discover the same perverseness, 
which led them to assert that almost all diseases of the geni- 
tals, were syphilitic. I have frequently seen them in persons 
who never had the syphilis : and one of these was a fine 
child, two years old, who was placed under my care by Dr. 
Fanning, of Brooklyn." — (Bus he on Diseases of the Rectum, 
dec, p. 224.) Inflammation of the fine skin and mucous mem- 
brane of these parts, is a cause of this affection ; friction of 
the parts ; compression, contusion, erasion, arising from filth 
and acrid secretions, or venereal poison. 

These excrescences are liable to be confounded with carci- 
nomatous tubercules, polypi and hemorrhoidal tumors ; but 
by examining carefully the description of each of these, this 
error will not be likely to be committed. 

About five years ago, I cured a lady who labored under 
this disease, who had previously been treated by an eminent 
Surgeon, who pronounced her case to be cancer. I found 
the anal canal almost completely filled up with moist fungus 
vegetations, which greatly interfered with her fsecal dejec- 
tions. In 1841 I cured a Mr. Thompson of this disease. He 
had formerly drove the stage between Lexington and Cincin- 
nati, and was the worst case I ever saw, or heard tell of. 
He could not sit at all. His excrescences were exceedingly 
numerous, hard and warty ; and they constantly discharged 
an acrid matter, which kept the adjacent parts so excoriated 
that he could scarcely get about. He had them twice cut 
off before I saw him, but it only added new life to them, 
they grew much faster than before. I now have an excel- 
lent drawing which I had taken of this case. Mr. Thompson 
has been entirely well of his disease ever since, and I believe 
he resides at present in Augusta, Georgia. 



CHAPTEE XYI. 
Polypus of the Pectum. 

Why the term polypus should have been used to designate 
the tumor so called in surgery, is a question not so easily 
answered, unless it was so denominated from an erroneous 
impression that such tumor possessed several roots, feet or 
fibrils, like the sea animal of that name. Nothing, however, 
could be more foreign from the truth, than such an im- 
pression ; for a polypus so denominated in surgery, has gen- 
erally but one root, foot or base. I have, however, in my 
practice, seen as many as three rectal polypi, each of which 
had several adhesions or attachments to the mucous mem- 
brane in the form of small slender roots or feet, doubtless the 
result of plastic inflammation ; but such cases must be rare 
indeed. 

The rectum, like the mucous cavities of the nose, the womb 

and the vagina, is sometimes the seat of the peculiar growths 

termed polypi. Pectal polypi are considered by most all 

authors, as a disease of rare occurrence. Sir A. Cooper says, 

that in the whole course of his practice, he met with only ten 

cases — that the disease generally occurs in children, and very 

rarely in adults — and that the most advanced age at which 

he met with it, was twenty-two. {Lectures by Tyrrell, p. 

307.) " The extreme rarity of this disease," says Mr. Syme, 

" may be estimated from the statement of Sir A. Cooper." 

{On Diseases of the Rectum, p. 102. Edinburg, 1854.) Dr. 

Bailie says, that polypi of the intestines are by no means fre- 
14 



210 POLYPUS OF THE RECTUM. 

quent. {Morbid Anatomy, p. 161.) He, however, formed 
his opinion from the result merely of post-mortem examina- 
tions. 

My opinion is, that this disease is much more common than 
is generally supposed. It is often overlooked, or mistaken 
for haemorrhoids or for prolapsus of the rectum, especially in 
children — as it resembles both these diseases in several par- 
ticulars, and quite liable to be confounded with them. I 
have known this error to be committed in numerous instan- 
ces. A careful examination should therefore always be made 
before pronouncing a positive opinion as to the true nature 
of the case ; for this disease is much more serious than either 
piles or prolapsus, being so liable to degenerate, or become 
malignant in its character. In the course of seventeen years 
practice, I have treated eighteen cases of this affection — ten 
of which occurred in females, and the remainder in males. 
Of the former, three were under five years of age, and the 
remaining seven were between the ages of nineteen and six- 
ty. Of the latter, three were between the ages of one and 
three years, and the remaining five were between the ages 
of twenty-five and sixty-five. Fifteen of these cases were 
treated with success, and three died, being aged persons, and 
the disease having assumed a malignant character. Dr. 
Bushe says, " That if we may form any opinion from the 
cases of polypi of the rectum that have been recorded, they 
appear to have generally occurred in adults, and for the most 
part in females." (On Diseases of the Rectum, p. 228.) Mr. 
Syme says that, " Most of the cases that have fallen under 
my own observation, were persons who had attained or passed 
the middle period of life. In five which by a curious coinci- 
dence, came under my care, in the course of a little more 
than a fortnight, two were in adults, and three in children." 
(Libro Citato.) 



POLYPUS OF THE RECTUM. 211 

Description of Rectal Polypi. 

These tumors are liable to form in different parts of the 
rectum, high up, as well as low down ; but they are usually- 
found attached to the mucous coat, two or three inches above 
the verge of the anus; yet sometimes still higher up, and 
beyond the reach of the finger. They are of different sizes, 
varying from that of the smallest pea, to that of a large 
cherry, hen's egg, or larger ; being so small at first, that they 
can scarcely be felt ; but if no remedial measures be adopted 
to arrest their growth, they continue to increase in size until 
they sometimes acquire great magnitude. Boyer mentions 
a case in which the polypoid tumor was as large as two 
fists. (Traite de Maladies. Chirurgicales. tome. V., jp. 76. 
Bruxalles, 1828). Bailie reports the case of a polypus which 
grew in the sigmoid flexure of the colon, which was as large 
as the fist. (Libri Citati.p. 162.) In March, 1849, I removed 
a polypoid tumor the size of a hen's egg, from the rectum of 

Miss S , of Louisville, Ky. This was the largest tumor 

of the kind I ever saw. These tumors are either solitary or 
multiplied. In the largest number of cases that have come 
under my observation, they were single, and this I have no 
doubt is usually the case. They are smooth or lobulated on 
their surface, and pearlike shape or round. . When pear- 
shaped, they are attached by means of a narrow neck, or 
ligamentous peduncle of various lengths ; but when round, 
they generally have a broad base, and are often immovable. 
Their texture varies from soft or lacerable, which is most 
common, to being firm and unyielding, like cartilage. When 
soft, they feel like the mucous membrane of the rectum, and 
indeed often resemble it in appearance. Their color is 
usually a dark red ; but is sometimes bright, just according 
to the number of blood vessels by which they are supplied. 



212 POLYPUS OF THE RECTUM. 

Sometimes, however, their color is whitish, or a dirty yellow. 
They generally possess but little sensibility. 

With regard to the true nature of these abnormal growths, 
nothing very definite can be said. They are either of the 
mucous or the sarcomatous (fleshy) species of tumor. They 
are generally, however, of the former. The mucous species 
are slowly developed ; usually of small size, of soft consist- 
ence, prone to bleed, and have a slender and friable pedi- 
cel ; whereas the sarcomatous or fleshy species on the con- 
trary, often grow rapidly and attain great magnitude, and 
are liable to become malignant. 

Symptoms of Rectal Polypi. 

In their commencement, polypoid tumors of the rectum 
are unattended by any symptoms sufficiently marked to call 
attention to their existence. As soon, however, as the tumor 
has become well developed, it generally gives rise to an exu- 
dation of mucus and blood mixed, which will soil the 
patient's linen ; and sometimes, there is even a flow of pure 
blood takes place from the anus, without any admixture of 
mucus. The patient will sooner or later begin to be affected 
with a heavy dragging pain at the seat of the tumor, or 
tumors ; weight and fullness in the lower bowel, tenesmus 
and a sensation as if some foreign substance were in the rec- 
tum, with considerable difficulty in evacuating the bowels. 
When the stools are of a certain consistence, they are usually 
contracted and generally covered with blood, mucus or pus, 
so as to lead to the belief that a stricture of the rectum 
existed. If the tumor is situated low down, it will be pro- 
truded at each evacuation of the bowels, and if large it will 
have to be returned with the fingers, and with more or less 
difficulty, especially if it is of a pyriform shape. If in con- 
sequence of the shortness of its pedicel, or from its being 
attached high up in the intestine, the tumor cannot be pro- 



POLYPUS OF THE EECTUM. 213 

traded, or prolapsed, so as to be brought to view, the finger 
should be introduced into the rectum, which can easily be 
.done, even in young children, when, if in reach, its existence 
will readily be detected : if, however, the tumor is beyond the 
reach of the finger, the speculum ani should be used, which 
will at once bring it to view. Gradually the digestive func- 
tions become affected, and after the patient has for some time 
suffered from the train of unpleasant symptoms, consequent 
upon this state, diarrhoea and hectic fever supervene, and he 
is reduced to a state of emaciation and extreme debility. 
These symptoms may be entirely the result of the irritation 
of the body of the tumor ; but they are often greatly aggra- 
vated by the ulceration which usually takes place, either on 
the surface of the tumor itself, or on the surface of the adja- 
cent mucous membrane of the rectum ; even if there should 
be nothing of a malignant character in the disease. This 
affection is most always attended with danger, and if 
neglected might degenerate, and sooner or later prove fatal. 
This is pre-eminently so, with regard to the sarcomatous 
species. In this species, as the tumor increases in size and 
malignancy, the patient will become sallow. His tongue 
will be coated ; his thirst will be intense ; and he will lose 
his appetite. He will be troubled with flatulence, and colic 
pains. He will emaciate ; his extremities will swell, and 
hectic fever will set in. His discharges from his bowels will 
be small in quantity, and voided with great difficulty. These 
symptoms will continue to increase, until death closes the 
scene. 

For malignant polypi of the rectum, see the chapter on 
Malignant Degeneration, or Cancer of the Rectum. 

Causes of Rectal Polypi. 

The causes of this disease are by no means well under- 
stood. It appears to be a spontaneous affection, often occur- 



214: POLYPUS OF THE RECTUM. 

ring in persons who were previously healthy. Among the 
predisposing causes, the lymphatic temperament, the her- 
petic, syphilitic or scrofulous taint, and sedentary employ- 
ment, might be mentioned. 

The Diagnosis of Rectal Polypi. 

Polypus of the rectum is liable to be confounded with 
dysentery, haemorrhoids and prolapsus of the rectum — this 
is especially so in children. From dysentery it may be dis- 
tinguished by the absence of almost every other symptom 
peculiar to this affection, with the exception of the blood in 
the evacuation. From haemorrhoids it is to be distinguished 
by its soft spongy feel, by its being incapable of sudden erec- 
tion or collapse, by its slow growth, &c. From prolapsus of 
the rectum it can readily be distinguished by a careful 
examination. In polypus, the faeces always escape at the 
side of the tumor, if noticed ; whereas in prolapsus of the 
bowel, the opening through which the faeces are discharged, 
will be observed to be at the centre of the tumor. Polypus 
of the rectum in children, which is by no means uncommon, 
is often mistaken for prolapsus of the rectum, and most seri- 
ous consequences sometimes result from the treatment in 
such cases. In the fall of 1844, I removed a polypus, the 
size of a pullet's egg, from the rectum of a little girl five 
years old, the daughter of Mr. K , of Golconda, Illi- 
nois. This little patient had been treated for prolapsus of 
the rectum for upwards of a year, by tonics, and the most 
powerful astringents, but in vain. I observed in three cases 
of polypus of the rectum of children, that the tumor in each 
one had the exact appearance, when protruded, of a large 
ripe cherry, deprived of its epidermis. 

Spontaneous Cure of Rectal Polypi. 
These tumors are sometimes detached by the efforts at 
stool, and a spontaneous and generally a perfect cure is the 



POLYPUS OF THE RECTUM. 215 

consequence. The polypus being protruded, it may be sepa- 
rated from its adhesion by the action of the sphincter ani 
muscles ; or it may become detached by the rupture of its 
pedicel, during the passage of hardened faeces. A case of 
this kind came under my notice in New Orleans, in January, 
1850. Mrs. J. "W*. P , aged 40, residing on Magazine- 
street, consulted me for what she thought was a pile tumor, 
and from which she had suffered much inconvenience for 
four or five years. I found, upon examination, that the 
tumor was a polypus the size of a large hickory-nut, and 
proposed its- removal. She consented, but deferred the 
operation two weeks, on account of some family arrange- 
ments. About ten days after this, I was one day sent for in 
haste to see Mrs. P , who, when I saw her, to my sur- 
prise told me that she had just had an evacuation from her 
bowels, and in her efforts the tumor passed into the chamber 
with the fseces, and that a slight bleeding was taking place, 
which was the principal cause of my being sent for. This 
lady has remained entirely free from the disease since, now 
four years. 

Letters from Persons Afflicted with Bectal Polypi. 

LETTER A. 

N T , October 3, 1842. 

I have not seen my mother-in-law, since I saw you, until to-day. 



She has just given me a full history of her case, and I believe as you do, 
that it is not simply piles, as we thought. She says that she first noticed 
the tumor about four years ago j it was thin and quite small, but it has 
been gradually growing ever since. It has never given her much pain or 
trouble until within the last year. At every stool, now, it comes down, 
and it is as large as a small pear and precisely the same shape. It feels 
very soft, just like a piece of liver, and pressing it does not in the least 
hurt it. When it comes down, it cannot be returned sometimes for three 
or four hours j so that she has frequently thought of just cutting it off her- 
self with a knife, but she was afraid. She has never had it examined by 
any physician; but she has consulted several, and they have called it the 
piles, and that it should be cut off with the knife. As it never pained her 



216 POLYPUS OF THE EECTUM. 

very much, she determined not to have it cut off, as long as she possibly 
could avoid it. She thinks it has grown more within the last six months 
than during the whole four years, and there is now quite a discharge of 
bloody mucus, and a smarting pain when at stool, and until the tumor is 
returned. Her general health is gradually becoming impaired, which we 
have all noticed within the last six months. She is forty-five years of age, 
and the mother of five children. If from this description you think you 
can cure her without her visiting you, which she would greatly prefer, 
please let us know as soon as you receive this. If you cannot, we will try 
and visit you by the first of December. Please say what length of time 
she will have to be under your treatment ; what board can be obtained for, 
and what probable amount your fee will be, so that we can prepare 
accordingly. 

The lady alluded to in the above letter visited me at Lou- 
isville, E/y., in a few months after the date of the letter, 
when I removed the tumor, and she remains well to the pre- 
sent time, now twelve years. 

In October, 1848, Mr. , aged 30 years, a merchant of 

Louisville, Ky., consulted me for a singular tumor, as he 
called it, of the lower bowel. He at first thought it was a 
pile, but from its freedom from pain, its slow growth, its 
great length and singular shape and feel, he concluded it 
could not be a pile tumor, but might perhaps be a loose por- 
tion of the lining membrane of the bowel itself. He had 
observed it for the last six years ; it was completely protru- 
ded at each stool, and returned immediately after of itself, 
without the least trouble or pain. Upon examination, I 
found it to be a very vascular tumor, two and a half inches 
in length and about one fourth of an inch in diameter, hav- 
ing the color, the feel, the shape, and the general appearance 
of an earth worm, though considerably larger. I removed it, 
and the gentleman remains free from a similar growth since, 
as the following letter will show. Sir A. Cooper is the only 
author whom I have read, who has observed a similar poly- 
poid growth. — (Libro citato.) 



NEURALGIA OF THE ANUS. 217 

LETTER B. 

Louisville, January 5th, 1855. 
Dear Doctor — I have just received yours of the 1st instant, and in 
answer to your inquiry, take great pleasure in informing you that there 
never has been the slightest indication of a return of any similar tumor, 
since you removed the one from my bowel in 1848. 

I am truly yours, &c. S D . 

Dr. W. Bodenhamer, New York, 



CHAPTER XYIL 

Neuralgia of the Anus. 



Neuralgia, as its name implies, is a disease of a nerve — 
nerve-ache, the principal or leading symptom of which is, 
agonizing pain — pain emphatically. 

Anal neuralgia is an extremely painful, but fortunately a 
rare disease ; yet occasionally cases do occur, and for this 
reason I have noticed it in this work. It is, however, 
doubted by some, whether the anus is ever, in reality, the 
primary seat of this disease, or whether it is really and essen- 
tially neuralgic in its character. That the anus is sometimes 
the seat of a morbid exaltation of sensibility, independent of 
any perceptible inflammatory action or appreciable organic 
alteration, to account for the extreme pain experienced, is a 
fact which cannot be denied. This I would denominate neu- 
ralgia of the anus, and I can see no good reason why real 
genuine neuralgia, may not just as well be primarily seated 
in the anus, as in any other part of the body ; and why it 
may not be precisely similar in its character to that which 
occurs in the face, the limbs, &c. 

Dr. Bushe is of opinion, that, in the majority of cases 
described by authors, in which both the anus and genito- 
urinary organs were said to be the seat of neuralgia, no such 



218 NEUKALGIA OF THE ANUS. 

disease affected the anus ; but that in consequence of irrita- 
tion in the genito-urinary apparatus, the sphincter ani was 
thrown into a state of painful contraction. Dr. B. then 
goes on to relate the " only genuine" case of neuralgia com- 
mencing in the genito-urinary organs, and from thence extend- 
ing to the extremity of the rectum, which has come within 
his observation. {Bushe on the Rectum, dec, p. 111.) 

Symptoms of Anal Neuralgia. 

Like neuralgia of any other part, that of the anus com- 
mences with an undefined sensation of pain in the affected 
organ itself. Sometimes this pain is sharp, lancinating and 
paroxysmal ; sometimes dull and aching ; but in whatever 
manner it displays itself, it is seldom confined to the anus 
alone, but extends itself to the perinseum, to the urethra,, to 
the vagina, to the bladder, to the middle of the thighs, or to 
the sacral and lumbar regions. It often comes on at a cer- 
tain hour, gradually increasing, and then declining in inten- 
sity for a period of time varying from two to six hours, and 
leaving behind it a distressing sensation of soreness in the 
anus and anal passage. 

Yelpeau says that the anus, in this affection, is entirely 
free from redness, and from swelling ; neither can the slight- 
est alteration be perceptible, but the patient soon becomes 
convinced that it is the seat of lancinating pains, which 
cause him to dread the least pressure of the parts. These 
pains frequently come on in paroxysms ; sometimes sud- 
denly, at other times more slowly ; leaving the patient 
entirely free from pains during the intervals. In other cases, 
however, the pains are constant, with but occasional exacerba- 
tions. In some persons, the anus appears to undergo momen- 
tary and forcible contractions, followed by speedy relaxa- 
tions ; in others, on the contrary, it is seen to expand to such 
an extent, that involuntary discharges take place. The pain 



NEURALGIA OF THE ANUS. 219 

frequently extends from the anus to the loins, to the back 
and to the urinary organs. Sometimes the evacuation of the 
bowels, as well as the bladder, is attended with difficulty and 
with the most excruciating pain. {Diet de Med. t. Hi. p. 282.) 

Causes of Anal Neuralgia. 

Neuralgia of the anus may be caused by exposure to cold 
and damp, especially sitting on cold and wet seats. It is 
often, doubtless, induced by the influence of malaria ; atmos- 
pheric changes also exert a powerful influence on the disease. 
It is often induced or accompanied by irritation of the womb 
and vagina in the female, and of the testicle in the male, or 
of the urinary organs in both sexes. It sometimes arises from 
irritation in some remote portion of the alimentary canal, 
such as the stomach, small intestines and colon ; either one 
or the other of these being highly irritated, might be the pri- 
mary source of this affection. In the largest majority of 
cases, however, the cause, in my opinion, will be sought for 
in vain — it will be left in the same obscurity that it is in 
cases of neuralgia of other parts. The memory of the patient's 
sufferings, says a fine writer, is the only evidence of the dis- 
ease — the pain has left no trace behind it — no guide for the 
future — no explanation of the past. 

Persons of a nervous and irritable temperament, and who 
are subject to this disease in other parts, are most liable to 
this affection. Persons who have been debilitated by acci- 
dental losses of blood, by diseases of a depressing nature, or 
by excesses and irregular habits, are also prone to the dis- 
ease. 

This disease sometimes continues for life, rendering the 
patient miserable. I have in my practice, treated five 
marked cases, and with complete success. One, I recollect 
well, a southern gentleman, who had labored under the dis- 
ease about five years ; he remarked that during that time he 



220 NEURALGIA OF THE ANUS. 

had taken at least five gallons of laudanum, and that he had 
been cupped and blistered along the spine, until the skin had. 
become as rough and as thick as an alligator's ! This gentle- 
man had but one paroxysm of his disease after I commenced 
treating his case. My treatment generally gives immediate 
relief. 

A full report of the character and treatment of these cases 
will be given in my forthcoming work on the treatment of 
diseases of the anus and rectum. 

Dr. Bushe describes a case in the following manner : " In 

1829, 1 was called to see Mrs. H , a nervous lady, about 

thirty years of age, who for several months had suffered from 
lancinating pain in the extremity of the rectum. For weeks 
this pain would be very severe, and then nearly, but not 
altogether, subside. Her distress was greatest towards. the 
close of the day, and then she was compelled to take Hack 
drop. Changes of temperature had a baneful influence on 
her, not only increasing the pain in the anus, but rendering 
her restless and melancholy. Her bowels were generally 
constipated, to remedy which, she generally took three doses 
of magnesia every week. During defecation, her distress 
was very much increased, especially when the excrement 
was hard. I examined the parts with great care, but could 
not detect any lesion. There was no spasm of the sphincter, 
and she bore pressure on every part of the rectum that the 
finger could reach, without pain, save on a spot about the 
size of a shilling, on the left side of the intestine, rather less 
than half an inch above the verge of the orifice, which was 
so exquisitely tender, that she screamed out when the finger 
was pressed against it." {Bushe on the Rectum, p. 112.) 



CHAPTER XYIII. 

Spasmodic Contraction of the Sphincter Ani. 

This painful and troublesome affection, according to many, 
is always considered as of secondary origin ; depending 
entirely upon other diseases in the same vicinity, such as 
fissure, neuralgia, haemorrhoids, diseases of the genito-urinary 
organs, &c. Hence they do not view it in the light of a pri- 
mary disease, nor make it the subject of special considera- 
tion. That these morbid affections do often co-exist, is a 
fact, which has already been shown in this work. This, 
however, they may do, or they may not do. Yet there is a 
species of painful spasmodic contractions of the sphincter 
muscle, which cannot be traced to any primary affection 
whatever, either in the anus or elsewhere. And it is espe- 
cially this particular kind, which should be entitled to the 
consideration which I have given it in this work — a primary 
or substantive disease. 

Dr. Bushe, speaking on this subject, says, " The import of 
the word neuralgia is too well understood, to need any 
explanation from me. That the cases I have described 
under this head, merited such a place, will scarcely be 
doubted ; but whether those described under the title 
spasmodic contraction of the sphincter ani, should not be 
placed under the same head, is the question. I would just 
remark, that I think they ought not to be so arranged; 
because neuralgia of the anus cannot only exist without con- 
traction, but with relaxation of the sphincter ; and it is no 



222 SPASMODIC CONTRACTION OF THE SPHINCTER ANI. 

reason because contraction of this muscle is sometimes com- 
bined, and in such cases, is in all probability the conse- 
quence of neuralgia, that spasm of the sphincter, because 
painful, merits the appellation of neuralgia. I am disposed 
to think, that it would be as reasonable to style fissure, neu- 
ralgia of the anus, or cramp of the gastrocnemius muscle, 
neuralgia of the leg, as to class all the cases I have nar- 
rated under the head neuralgia." — (Bushe on the Rectum^ 
So., p. 129.) 

In this disease the sphincter muscle will be found firmly 
and painfully contracted, and not the slightest perceptible 
alteration whatever in the structure of the parts can be 
detected, by the most careful examination. The origin and 
cause of this affection are difficult to explain. Everything 
that tends to irritate the anus may be the cause of increasing 
the patient's suffering, such as introducing the finger or a 
foreign body into the anus — forcibly expelling indurated 
matters — using stimulating articles of food or drink. Anx- 
iety and distress of mind are said to have a powerful influ- 
ence in confirming and aggravating its symptoms, and may 
not improbably also occasion its commencement. 

The symptoms of this disease resemble those of fissure of 
the anus very much ; but if a minute examination is made, 
neither fissure nor the slightest abrasion of the surface can 
be discovered, and the anus, instead of presenting its ordi- 
nary conical appearance, will look flat and scarcely present 
any trace of the orifice, owing to the powerful contraction 
of the external sphincter muscle ; and every attempt at 
introducing the finger will be attended with the greatest dif- 
ficulty and the most violent agony. Sometimes persons are 
suddenly seized with violent contractions of the anus, 
attended with almost insuperable suffering, without being 
able to assign any cause whatever. Defecation is usually 



ORGANIC STRICTURE OF THE ANUS. 223 

attended with difficulty and with severe pain. The urinary- 
organs also greatly sympathize. 

The most popular treatment of this disease is the division 
of the sphincter muscles, as in fissure of the anus. 

This treatment I reject, for I have never seen a case that I 
could not and did not relieve in twenty minutes, without 
resorting to it. Not long since, a gentleman in this city 
sent for me in great haste. I found him suffering the most 
agonizing pain. He informed me that he was suffering the 

agonies of the d d, and had been for the last five hours. 

I relieved him in ten minutes, and in as many more he was 
laughing and talking. I have treated a considerable number 
of persons of this disease. 



CHAPTEK XIX. 

Organic Stricture of the Anus. 

This contracted state of the anus may be induced by what- 
ever tends to excite inflammation in its lining membrane. Sir 
C. Bell says, " that the cause of the inflammation for the most 
part is costiveness and straining, by which the fibres are 
strained and burst, and become inflamed. Sometimes it may 
come from the tenesmus, and frequent excitement of the 
orifice, by painful and ineffectual calls to evacuations. (Trea- 
tise on Diseases of the Rectum, <&c. London, 1832, pp. 
321-2.) The most common cause of this condition of the 
anus that has come under my observation, is from the con- 
traction of cicatrices by operations on this organ, such as 
excision of hsemorrrhoidal tumors, or prolapsed membrane, 
&c. Dr. Colles in one of his lectures, says, " If you cut away 
any skin at the verge of the anus, you may depend on this — 
that although some time may elapse before the effect is pro- 



224 ORGANIC STRICTURE OF THE ANUS. 

duced, (and it is generally slow in its progress) you subject 
the patient to a very serious inconvenience during his life, 
arising out of the contraction of the aperture of the anus 
that results from it." 

The editor of Colles's Lectures, says, " I saw a gentleman 
who had been operated on four years before, by an eminent 
surgeon, and so small and rigid had the opening of the anus 
become, that no solid, larger than a garden pea, could be 
passed from the bowels, and with the miserable prospect of 
its gradually becoming still smaller." Cheselden says, " He 
saw a case where a bold unthinking surgeon cut off a part of 
a prolapsed ani, and the cicatrix afterwards was so hard and 
contracted, that the patient could never go to stool without a 
clyster, and then, not without great misery." " In fine," 
says Delpech, " it happens that in cases of habitual engorge- 
ment and eversion of the internal membrane of the anus, in 
consequence of the presence of haemorrhoids, in attempting 
the excision of the scroll, (i. e. the lateral tumors, formed 
by this slight shade of prolapsus,) which sometimes occasions 
insupportable inconvenience, the surgeon has extended the 
operation to the whole circumference of the anus. In these 
cases, it has frequently resulted from this practice, that the 
circular cicatrix has contracted the natural passage, and ren- 
dered it almost incapable of performing its functions." 

In many cases of contracted anus, there is merely a thick- 
ening and consolidation of the fine skin of the part, and of 
the adjacent cellular membrane. These often arise from 
syphilitic poison. I should have said that in all the forms 
of stricture of the anus, there is generally no disposition to 
spasm. 

The symptoms of this affection resemble very much those 
of stricture of the rectum, which will be treated of in the next 
chapter. At its commencement, it often does not occasion 
much inconvenience, except when the bowels are very much 



ORGANIC STRICTURE OF THE ANUS. 225 

constipated ; then there is pain and difficulty in passing har- 
dened fasces. After a while, however, the anus becomes so 
contracted, that nothing but fluids can pass through it. I 
have seen several cases where, it was impossible to get 
any thing into the amis larger than a common sized goose- 
quill. I have treated several cases of this affection with 
complete success. 

LETTER. 

N. 0. La. August 10, 1842. 
Dr. Bodenhamer — Dear Sir : I have just learned from a friend, that 
you are distinguished for curing a certain class of diseases. About one year 

ago, I was operated on by Dr. , for what he said were the piles ; 

but I always thought it was simply the falling down of the bowel, as it 
never gave me any pain as the piles do. The only trouble it was to me, 
was when I went to stool, I had afterwards to return it. When the doctor 
operated, he made me strain until the part came down well, and then he 
cut it off. It soon healed ; but now I am ten times worse off than before. 
The bowel has contracted so much, that I can scarcely stool at all, unless 
the stool is quite thin. I cannot have a hard stool. There is always an 
uneasy feeling about the parts, as if something was pulling or drawing 
them, which makes me miserable. I have been trying bougies and every 
thing else that I could hear of, to no purpose, and I fear that I have been 

by this OPERATION RENDERED MISERABLE FOR THE BALANCE OF MY 
LIFE." 

I cannot dismiss this case without remarking, that the treat- 
ment certainly was unnecessarily operative. This is not a 
solitary case. I have met with several, and they should be a 
warning to the surgeon, how he operates about the anus, and 
to the patient, how he submits to such operations. 



15 



CHAPTER XX. 

Stricture of the Rectum. 

This is a rare, but a very distressing malady, and one that 
has heretofore been but little benefited by surgical mea- 
sures. Therefore, a successful method, not of treating it, 
but of curing it, would be truly acknowledged a desid- 
eratum. 

If one might judge from what surgical writers say on the 
subject, the treatment of stricture of the rectum has hitherto 
been a mere matter of pecuniary speculation — that this dis- 
ease has been the " golden egg, both of the regular and irregu- 
lar quacks." But why should it be so ? Can not a stricture 
of the rectum, in any portion of this canal, be discovered 
with certainty ? Who will dare say that it cannot. It is 
certainly not out of reach, even if it is out of sight. Is it 
impossible to discover a stricture of the rectum when beyond 
the reach of the finger? I answer unhesitatingly, it is 
not, and this I will prove to a demonstration in my forth- 
coming work on the diseases of the rectum. If surgeons gen- 
erally would pay more attention to the anatomy and the 
pathology of the rectum, they would soon be enabled to 
detect the slightest aberration from a healthy state of this 
organ, and then they would soon take the wind out of the 
sails of the quacks, gain the confidence of the community, 
and be consulted in such cases. Students should study well 
the anatomy of this organ, and frequently make operations 
on it in the dead body. In this way they would become 



STRICTURE OF THE RECTUM. 227 

adroit in their manipulations, and become conversant with 
the anatomy of it. I will now, for the benefit of the common 
reader, give the opinion of several eminent authors, respect- 
ing the quackery and the pecuniary speculation that often 
obtain in the treatment of stricture of the rectum. The fol- 
lowing graphic remarks from an able reviewer, are made in 
relation to this disease. 

"It is in this disorder that quackery rejoices. Occurring 
out of sight, (if the quack may be trusted, out of reach also,) 
the charlatan lies with comparative impunity, and trusts to 
darkness to shroud his doings. Though stricture of the rec- 
tum is seldom seen after death, it is wonderfully common 
during life. A patient has constipated bowels, he naturally 
applies to a rectum doctor ; the doctor takes a long bougie ; 
it hitches of course at the lateral turn of the rectum, or higher 
up than that — the case is one of confirmed stricture — the 
patient is doomed to be fleeced. Woe to him, or her, if he 
or she is rich ; for it is rich people who have stricture of the 
rectum. Once in the hands of the charlatan, and deliverance 
is far off. The doctor takes care to insist on the necessity of 
employing some one who understands the introduction of 
long instruments, and he naturally and properly congratu- 
lates the patient on his fortunate application to Kim. The 
bait too often takes, and the stricture is a confirmed one, so 
long as it pays." {Medico- CKirurgical ^Review, vol. IX. p. 
18, — 1838.) " Before I finish this note, I may mention that 
the inexperienced are apt to refer the opposition offered to the 
passage of the bougie, by the folds of the mucous membrane, 
or the projecting ridge of the sacrum, to stricture of the gut. 
I am mortified to add, that I have good reason for supposing 
that there are a few who make a profitable trade of treating 
dyspeptic patients for stricture of the rectum, asserting that 
the obstruction is high up, when in truth, this intestine is 
perfectly free from strictural disease. . Such practitioners, by 



228 STRICTURE OF THE RECTUM.. 

passing bougies, apparently cure what in reality never 
existed, and thus obtain a character for skill in the treatment 
of this disease, which, in truth they do not possess." {Bushe 

on the Rectum, <&c.,jp. 266.) " the top of the sacrum 

naturally projecting forwards on the commencement of the 
rectum, in some degree opposes the entrance of any larger 
body, and this circumstance is laid hold of by the unprinci- 
pled or ignorant ; the patient is very often declared to labor 
under stricture of the bowel, when none exists. Some prac- 
titioners discover stricture in almost every patient with dis- 
ordered digestion." (Listen's Elements of Surgery, by S. D. 
Gross, M.D.,p. 451.) 

But let us " turn from this disgusting exhibition, to the 
consideration of this disease, as it is, and not as cupidity 
would make it." 

Stricture of the rectum may be divided into functional or 
organic, or in other words, into spasmodic, or structural. The 
former is merely a contraction of the coats of the rectum, 
without eithe'r thickening or induration of the textures. 
Whilst the latter consists of a morbid growth, attended with 
the symptoms, and prone to the changes which characterize 
malignant degenerations of structure. 

There is a considerable diversity of opinion with regard to 
the situation of stricture of the rectum — some contending that 
it is most always low down, not higher than three inches, 
and within reach of the finger, while others say that it is most 
always high up, from six to eight inches and higher. I will 
give the opinion of several eminent men on this point, which 

may not prove uninteresting to the reader. " Not 

unfrequently, the inner edge of the deeper sphincter ani, 
being the seat of this stricture ; and then the finger enters to 
the depth of the second joint, when it is obstructed by a sort 
of membrane, standing across the passage. Sometimes the 
stricture is more than two inches within the anus, and feels 



STRICTURE OF THE RECTUM. 229 

like a perforated septum." {C. Bell on the Rectum, dec, p. 
330, London, 1822.) " The ordinary seat of stricture of the 
rectum, is from two and a half to four inches from the ori- 
fice of the anus. But sometimes it occurs at a greater dis- 
tance, at from' six to seven inches for example ; and a -con- 
traction of the same nature is occasionally met with at differ- 
ent parts of the colon." {Mayo on the Rectum, dec, p. 165, 
London, 1833.) " In a few instances, the stricture has been 
seated so high up in the rectum, that it could be but barely 
touched with the point of the finger, until the patient was 
desired to ' force down,' and then a satisfactory examination 
of it could be made." {Collets Hospital Reports, vol. V.,p. 
139.) " Stricture of the rectum most commonly occurs near 
the termination of the anus, a little within the sphincter, but 
it may take place in any part of the rectum. Sometimes the 
whole bowel is lessened in diameter, and on other occasions 
the stricture is situated in the sigmoid flexure of the colon." 
{Allen's Operative Surgery, vol. LLL,p. 488.) "Stricture in 
general, is readily ascertained by examination with the fin- 
ger.") Liston's Elements of Surgery by S. D. Gross, M. L>.,p. 
451.) " It is generally ftfund about two inches and a half 
distant from the orifice, but may be situated much higher 
up." {Sy?ne's Principles of Surgery, p. 445, Edinburg, 1832.) 
" Independently of the malignant forms of diseases hereafter 
to be described, I have very seldom seen a contraction of the 
rectum which was not within the reach of the finger." 
{Bushe on the Rectum, dec, p. 265.) 

Causes of Stricture. 

The causes of this disease are not well known. Some 
suppose it to be caused by spasmodic contraction of the mus- 
cular fibres ; by inflammation ; by the venereal disease ; by 
the result of cicatrization of ulcers, which have affected the 
muscular tunic of the rectum, by subacute chronic inflamma- 



230 STRICTURE OF THE RECTUM. 

tion, which induces thickening of the tissues of the rectum, 
and contraction of its natural capacity ( Vide Plate VIII.) ; 
thus impairing the organization and function of the bowel, 
so as to render its action irregular and difficult, and event- 
ually to determine a complete and fatal obstruction. It is 
however very difficult to ascertain with any positive cer- 
tainty the circumstances whicli give rise to this affection. 
The analogy of what happens in other canals, would lead to 
the supposition that continued irritation of the intestine is 
probably the immediate exciting cause. One of the worst 
cases I ever saw of stricture of the rectum, was caused by 
an operation for fistula in ano. Wiseman relates a case 
which was also produced by the same cause. — {Chirurgical 
Treatises, t&c, p. 234-5.) Copeland says that stricture is 
sometimes the consequence of the operation for fistula in ano. 
— (Op. cit., p. 15.) This disease most always comes on 
slowly and insidiously, and even after it is perfectly estab- 
lished, the symptoms are well calculated to mislead the 
patient, as well as the surgeon, as to the real nature of the 
case. Dr. Bushe's description of the symptoms is so perfect, 
that I will transcribe it. " There p is a sense of weight and 
obstruction in the lower bowels, — uneasiness, distention, and 
occasional spasmodic pain in the abdomen, — eructations, — 
precordial oppression, pain in the site of the stricture, loins 
and sacral region, occasionally extending down the extremi- 
ties, — vesical irritation. — bearing down in females, — itching 
and heat about the anus, head-ache, nervous irritability, and 
dejection of spirits. The left colon is loaded with gas and 
fseces, as may be ascertained by an examination of the cor- 
responding iliac fossa. The urine is generally scanty, high 
colored and foetid, though I have seen a few cases, in which 
it was unusually abundant and limpid. The bile is also 
generally vitiated and scanty. When the disease has con- 
tinued for some time, the hemorrhoidal vessels become 



PLATE W 



Forlum of the colon and rectum Laid open 







a. Internal surface of the colon. 

h . Internal surface of Hie rectum. 

c Sbric fcured y ortioiLof I lie r ec turn 

d . The niortidLv contracted and 
thickened state oF (tie txrwel 
constiijifcm|> the stricture . 



STRICTURE OF THE RECTUM. 231 

engorged, and very commonly tumors form, which for the 
most part are produced by extravisated blood, and hence it 
is, that in old cases the skin about the anus becomes thick- 
ened and elongated. In consequence of irritation, arising 
from the stricture, an increased quantity of blood is determi- 
ned to this region, and its return is so much impeded by the 
condensation of the walls of the bowel, and the accumula- 
tion of indurated faeces, that abscesses form in the cellular 
tissue, near the anus, and degenerate into fistulas. The calls 
to stool are sudden, and amount to six or twelve in twenty- 
four hours : generally two, three, or more take place within 
a short time, and are accompanied with much straining, 
which in some instances, especially when the stricture is situ- 
ated high up, gives rise to protrusion of the mucous mem- 
brane. Much gas, and a small quantity of mucus, occasion- 
ally mixed with blood, is all that is commonly discharged ; 
but every two or three days faecal matter, in small pellets, if 
hard, and in long, round, angular or flattened portions of 
small diameter, if soft, is expelled. After each attempt, 
though the pain is very moderate, a sensation continues as if 
the bowels had not been emptied, and this is the reason why, 
in these cases, several evacuations, such as they are, follow 
one another, at short intervals. When, however, a sufficient 
quantity of mucus or feculent matter has been discharged to 
give temporary relief, and from habit the amount is very 
trifling, the patient, who has been fatigued, desists from fur- 
ther attempts, until a sense of fullness indicates the necessity 
of making another effort. Occasionally, when the fasces 
accumulate above the stricture, which they often do in 
immense quantity, they are rendered fluid by an abundant 
secretion from the mucous membrane ; in consequence of 
which the patient is enabled to discharge nearly or perhaps 
all the accumulated matter ; thus by an effort of nature, 
fatal consequences are warded off. When the stricture is 



232 STRICTURE OF THE RECTUM. 

fully within the reach of the finger, the canal feels narrow, 
indurated and unyielding, for a greater or less extent, and in 
some instances we are able to pass the finger through the 
obstructed portion. Occasionally, it is rather higher than 
we can reach ; but in such cases, if the patient bears down 
forcibly, the diseased portion of the intestine will so far 
descend as to admit of the requisite examination." — (Bushe 
on the Rectum, p. 273-6.) 

Occasionally, persons labor under this distressing disease 
for months, and even for years, accompanied with but slight 
alvine difficulty and sympathetic disturbance. But sooner 
or later, the health declines, the body wastes away, and they 
die, worn down by sickness, inanition, and the dreadful spas- 
modic pains arising from the violent efforts of the bowel to 
overcome the obstruction. When emaciation has progressed 
to a great extent^ the powerful peristaltic action may be felt 
and even seen, heaving the abdominal parietes in tracts, cor- 
responding to the convolutions of the intestines. Purulent 
matter is also discharged in great abundance, and so acrid 
as to excoriate the anus ; this frequently comes away when 
the patients cough, or assume the erect posture. 

Yarious diseases in the vicinity of the rectum may simu- 
late stricture of the rectum; but the diagnosis is always 
easily determined by a careful and minute investigation of 
all the parts. 

I have treated eight cases of this distressing disease, three 
were females, and five were males. Three were complicated 
with fistula in ano. Five out of the eight, were perfectly 
cured ; the remaining three were very much benefited. 
They are all, to the best of my knowledge, still living. One 
of the cases cured, was a lady who resides in Kentucky, and 
who labored under the disease for ten years. Several years 
ago she was treated in Louisville, in Cincinnati, and in Lex- 
ington, Ky., for her stricture. "When I first examined her 



MALIGNANT DEGENEKATION OF THE RECTUM. 233 

case, I could only pass a bougie through, the stricture, about 
the size of a common goose-quill. She has been cured about 
five years — 1846. 

Since the above cases were treated, I have cured the fol- 
lowing — a few among the worst cases of stricture of the rec- 
tum I have seen. 

Capt. J. Hix, aged 49, Jackson, Mississippi. His stric- 
ture was complicated with an anal fistula. Cured in the 
spring of 1844. 

C. D. Bunce, aged 30, clerk, New Orleans, La. ; cured 
in the winter of 1846. 

Preston Grace, aged 49, brick mason, Paducah, Ky. ; 
cured in the spring of 1848. 

George Salladay, aged 63, farmer, "Wheelersburg, Ohio ; 
cured in the fall of 1848. 



CHAPTEK XXI. 

Malignant Degeneration of the Kectum. 

This is the most formidable malady yet treated of in this 
work, being the most rapid in its progress, and the most fatal 
in its termination. 

By the term malignant, I mean a disposition in the morbid 
tissue to be destroyed, sooner or later, by ulceration, or by 
sloughing, and a tendency in the system to the formation of 
similar morbid tissues, whether the primary one is removed 
or not. But there are some growths and alterations of the 
rectum that appear to be between the malignant and non- 
malignant. They tend strongly to their own destruction by 
sloughing or by ulceration, and in this respect, they are 
malignant. But the system shows no disposition to regen- 



234 



MALIGNANT DEGENERATION OF THE RECTUM. 



erate them, when they are removed, or to develqpe them in 
other parts, and in that respect, they are not malignant. 

I mean, then, by the phrase, malignant degeneration of the 
rectum, simply, cancer of the rectum, which designates gene- 
rically various organic alterations, whose inherent nature is 
unknown to us, but which, though of various forms and 
appearances, constitute one and the same lesion, and have 
as common characters, the property of changing and disor- 
ganizing the texture of the rectum, and the tendency to 
spread both superficially and deeply, and are usually beyond 
the resources of surgical art. 

It is difficult to describe cancer of the rectum, in conse- 
quence of the numerous and varied forms it assumes. Some- 
times it appears simply as an ulcer,. accompanied with vege- 
tations and hardened points, still in a scirrhns state. Some- 
times the finger, when introduced into the anus, sinks into 
the cellular tissue, or into a slough, from which it returns 
covered with matter remarkably foetid. In such a case, the 
patient is generally tormented by constant pain, diarhcea and 
erratic fever : his face has quite a yellow tinge, and he 
exhales a most offensive and characteristic odor. These evi- 
dences reveal to the most inexperienced the true nature of 
the disease, and of its fast approaching fatal termination. At 
other times the picture is less sombre, and there will be found 
a dry ulcer, without pain ; but it will rapidly eat away the 
cellular tissue, like those destructive cancerous ulcers of the 
face. Sometimes the rectum is filled with vegetations, and 
they often even project some distance beyond and around the 
anus, and completely obliterate this orifice. These vegeta- 
tions are sometimes quite soft, are easily torn, and bleed upon 
the slightest touch ; they often secrete the most surprising 
quantity of fluid, so much as to pass through the bed clothes, 
or to require constant dry napkins. This secretion emits a 



MALIGNANT DEGENERATION OF THE RECTUM. 235 

most disagreeable odor, and being highly acrid, excoriates all 
the parts with which it comes in contact. 

The diagnosis of the various forms of cancer of the rectum 
at an early stage, rest in great obscurity. It is true indeed, 
some authors have attempted to lay down characteristic signs 
by which to determine the true nature of the disease ; but 
these, however, will often be sought for in vain by the bed- 
side of the patient, and it will sometimes be found next to 
impossible to determine positively whether the disease is 
really cancer or not. I have cured several cases which had 
been pronounced cancer of the rectum by some of our most 
able surgeons, which were evidently not so, or I could not 
have cured them. My opinion is that many of the forms 
that true cancer of the rectum assumes, are generally not 
cancerous in their origin or incipient stage, but gradually 
become so as the disease advances. 

These malignant alterations of the rectum, as just defined, 
have been distinguished into cartilaginous, (gristly,) lar- 
daceous (resembling lard) and encephaloid, (resembling brain,) 
by Dr. Bushe, whose description of them, though imperfect, 
is the best I have seen. Indeed a good description of them, 
still continues a desideratum. 

Dr. Bushe observes, that " the cartilaginous disease may 
either commence in the form of hard tubercles on the mucous 
membrane, or in the muscular coat of the intestine, which is 
by far the most common ; the fibres become pale and firm, 
while the connecting cellular tissue undergoes a similar pro- 
cess of condensation, without any alteration of color. As the 
deposition goes on, the cellular tissue frequently becomes 
lardaceous ; but however this may be, the walls of the bowel 
increase in thickness, and the cellular and muscular tunics 
are sooner or later confounded and softened. Sometimes the 
mucous membrane becomes studded with lardaceous and 



236 MALIGNANT DEGENERATION OF THE RECTUM. 

encephaloid vegetations, while the serous coat presents car- 
tilaginous tubercles. 

As I have just mentioned, the lardaceous transformations 
may be superadded to the cartilaginous ; but I have seen two 
cases in which it was uncombined. In one of these, the mus- 
cular tunic and the cellular tissue were thus transformed, 
while in the other, the mucous coat was studded with vege- 
tations of this character. Finally, I have seen a case in 
which the muscular tunic and cellular tissue were lardaceous, 
while the mucous coat threw out encephaloid growths. 

The encephaloid transformation is sometimes primary, 
commencing in the cellular tissue or mucous membrane ; but 
more commonly, it is the sequel of the cartilaginous or larda- 
ceous degenerations. 

From the changes of structure above described, the cavity 
of the intestine is diminished, but this is not at all in propor- 
tion to the amount of disease ; for the quantity of carcinoma- 
tous matter in any one part may not be great, though several 
inches of the intestine may be diseased. Indeed, it fre- 
quently happens, that though the bowel may have been 
considerably obstructed for some time, the softening down 
and separation of the projecting masses, again render it per- 
vious. 

Any portion of the rectum may be first attacked. It most 
commonly, however, commences at its junction with the sig- 
moid flexure of the colon ; then immediately above the pouch, 
and lastly at the anus. 

The adjacent organs are most commonly involved in dis- 
ease. I have seen a case in which the bladder was perfo- 
rated, and two, where the recto- vaginal septum was exten- 
sively destroyed. "When the finger is introduced, we may dis- 
cover, firstly, that the intestine is firmer than usual, and a por- 
tion of its inner surface is covered with indurated tubercles. 
Secondly, that it is hard and contracted for a considerable 



MALIGNANT DEGENERATION OF THE RECTUM. 237 

extent, and the mucous membrane studded with ulcers, more 
or less extensive, whose surface is unequal, granular or 
fungous, and surmounted with thick, hard, and everted 
edges. Thirdly, that a firm cartilaginous ring, generally 
with an uneven surface and so extensive as barely to admit 
the extremity of the finger, occupies its circumference. 
Fourthly, that a portion of its inner surface is rendered 
irregular, and its cavity lessened by soft fungous growths ; 
and fifthly, that the disease is confined to its lower extremity, 
and a fungus is thrown out, either from a part, or all the cir- 
cumference of the anus. 

The causes of this horrid malady are involved in great 
obscurity. Some authors have endeavored to trace it to 
injury, or to inflammation, acting perhaps on a consti- 
tution predisposed to cancer; but such conjectures are 
more plausible than useful. Sometimes the cartilaginous 
transformation will last for years, while, on the contrary, the 
encephaloid runs a rapid course, destroying the patient in a 
few months. 

Those about or a little above the meridian of life, are most 
liable to this disease. No age, however, is exempt from it. 
I have seen the encephaloid transformation in a boy twelve 
years old, and the lardaceous in a female of twenty-three. 
From an examination of published cases, I find that women 
are most commonly its victims, and especially those who have 
recently ceased to menstruate. May not this arise from 
engorgement of the rectum, produced by the more frequent 
retention of faeces, and the suppression of the uterine flux ? 
"When a patient is affected with this disease, he suffers a 
burning pain in the rectum, which shoots through the pelvis. 
He is also tormented with a weight in the back, aching above 
the pubes, numbness of the thighs, and painful retraction of 
the anus. His stools are frequent, difficult, painful, scanty, 
slimy, dark colored, and mixed with blood and matter 



238 MALIGNANT DEGENERATION OF THE RECTUM. 

of an ichorous quality. In some instances, however, they 
are figured or composed of small pellets, and occasionally 
they are liquid, abundant, aud accompanied with dreadful 
tenesmus. He, moreover, labors under abdominal pain and 
distension, eructions, hiccough, nausea, and severe vesical 
irritation. Frequently, he cannot sit, and in some instances, 
is unable to walk, only obtaining relief in the recumbent 
position. He loses his flesh and strength ; the ichorous dis^ 
charge increases, and runs out when he coughs, or even when 
he stands erect. There is occasionally considerable hsemor. 
rhage, and he becomes sallow or leaden colored, cedematous, 
and sinks under continued suffering. Sometimes, however, 
when the disease is of a fungoid character, he may die from 
obstruction. 

The excessive shooting pain through the pelvis, the sallow 
or leaden color of the face, and the havoc made by the dis- 
ease in the advanced state, enables us to distinguish it from 
stricture. It must be confessed, however., that unless it com- 
mences in the form of indurated tubercles or irregular fun- 
goid growths, the diagnosis is not easy, in the commence- 
ment." {Bushe, on Diseases of the Rectum, p. 290-3.) 

With regard to the treatment of this horrid disease, it is 
unfortunately useless to say much. I will however, call 
attention to the operation recommended by surgeons -for the 
removal of this disease, viz: excision of the whole anal 
canal, or lower extremity of the bowel. This is a painful, 
cruel, unjustifiable, and unnecessary procedure, and one by 
w T hich the disease is often fearfully and painfully accele- 
rated — the knife only rousing it into fatal activity. Even if 
it ever could succeed, the patient would be rendered misera- 
. ble for life, and it would be proof positive that he might 
have been cured by other means. It is useless, however, to 
expend words on the reprobation of such a monstrous and 
extravagantly bad practice. 



MALIGNANT DEGENERATION OF THE RECTUM. 239 

M. Yidal (de Cassis) fully illustrates the serious results 
which follow this operation. (Traite de Pathologie externe, 
c&c, 2 me edit. tome. IV. y $$>. 716-19.) True cancer of the 
rectum, in my opinion, admits of no other but palliative 
treatment. 

There have also been a great variety of medicines recom- 
mended for the cure of cancer, not only of this, but of other 
parts of the body. Many of these, together with all the 
acrid and irritating external applications, are frequently 
worse than useless, being often exceedingly hurtful. The 
pretensions of empirics, in positively asserting that they have 
infallible remedies for the cure of cancer, &c, as well as the 
interference of kind friends .and acquaintances, who ever 
have their particular infallible remedies for every thing, too 
often deceive the patient, and prevent him from making 
application at the only time, perhaps, at which the disease 
might be arrested by proper treatment ; or from using those 
means which, if they did not entirely cure the disease, would 
keep it in subjection for the time being. 

I have met with six cases of cancer of the rectum, in my 
practice. I did not cure them. Three of these were females 
and three were males ; they were all between the ages of 
forty -five and sixty, except one, who was about twenty-eight. 
Although I did not cure one of these, I have every reason to 
believe that I greatly relieved three of them, and thus pro- 
longed their lives. 

One of these, Mrs. , of Tennessee, aged forty-seven, 

and mother of several children, consulted me in the fall of 
1841, for a cancer of the rectum, which she had labored 
under for about nine months. Previous to the appearance 
of the cancer, she had submitted to two operations for a 
fistula in ano. From the chasm, caused by the last incision, 
which was extensive, an irregular fungus growth sprung up, 
and spread so rapidly, that in a short time the tumor encir- 






240 



MALIGNANT DEGENERATION OF THE RECTUM. 



cled the entire anus, and was extending itself to the adjacent 
parts. This was her condition when I saw her. She died 
six months afterwards. These two operations were either 
the immediate cause of the morbid action in the rectum, or 
they gave great impulse to it, for immediately after the 
last was performed, the malignant growth commenced and 
rapidly advanced, whilst the general health in the same ratio 
declined. 

The great tendency to malignant alterations of the rectum 
in females, who have recently ceased to menstruate, and 
who appear to be the most common victims of this dreadful 
malady, should always deter surgeons from operating, even 
should there be no positive evidence of any malignant ten- 
dency at the time. 

Since writing the above, in 1846, I have seen eleven addi- 
tional cases of true cancer of the rectum. They are all now 
(1855) dead, to the best of my knowledge, except two. The 
most formidable of the eleven cases were the following four. 
S.' T. Magill, carpenter, St. Louis, Mo. ; J. Knox, farmer, 
Ghent, Ky. ; Charles F. McGhee, farmer, Washington, Indi- 
ana ; H. P. Porter, Fairfield, Indiana. All these cases will 
be fully reported in my forthcoming work on the Diseases of 
the Rectum, &c. 



CHAPTER XXII. 
Fistula m Pekly^o — Urinary Fistula. 

This is a very troublesome, inconvenient, and disgusting 
disease, compelling the patient, whenever called to pass 
urine, either to place himself in the same position required 
to have a faecal evacuation, or to be subjected to the neces- 
sity of having his clothes constantly wet ; owing to the urine 
passing through a fistulous *sinus, communicating with the 
urethra and the perinaeum. 

The disease is usually preceded by an abscess, situated in 
the perinaeum. The swelling commences slowly, generally 
assuming a chronic character, and its progress is marked by 
pain, hardness, shivering, and febrile disturbance. The col- 
lection, if suffered to do so, will sooner or later open sponta- 
neously, and frequently discharge at once, both matter and 
urine. The abscess does not close, but it partially contracts, 
and thus degenerates into a fistula in perinaeo. The discharge 
is usually thin and glairy ; sometimes it is thin, dark colored, 
and foetid, and often quite copious. Sometimes the abscess 
instead of opening in the perinaeum, opens into the rectum. 
In such cases, urine passes out of the bowel, and air, and 
even faeces, may, and do pass through, the urethra. At 
other times one branch of a sinus leads into the rectum, 
while another leads into the urethra, both having the same 
external opening in the perinaeum, through which urine and 
faeces pass. When the sinus enters near the neck of the 

bladder, there is a constant dribbling of urine, and the 
16 



242 FISTULA IN PERIN.EO— URINARY FISTULA. 

patient has to wear a sponge, or folds of cloth, to absorb it, 
and his life is thus rendered miserable. In other cases, the 
urine escapes only during the expulsive efforts at urinating. 
The surrounding parts are hardened to a greater or less 
extent, become tender and excoriated, and the patient is in a 
constant state of discomfort, and his general health suffers 
severely. There may be but one fistulous opening, or there 
may be several. Dr. Colles saw a patient who had from 
twenty to thirty openings in the perinseum and vicinity. I 
saw one who had fifteen, and urine passed through each one. 
Though there may be many external openings in the peri- 
neum, there is never more than one opening in the urethra, 
at one time. Sometimes a very large quantity of the urine 
passes through the fistulous canal. I once cured a case, 
where at least two-thirds of the urine passed through the arti- 
ficial opening. In such cases, the consequence is, that the 
urethra beyond the opening contracts, and will ultimately 
become obliterated, unless the fistula is cured. 

Causes of Urinary Fistula. 

The perinseum abounds in cellular tissue, and the corpus 
spongiosum urethra traverses this region, it is therefore a 
matter of no surprise, that inflammation should frequently 
spread into this tissue, and occasion suppuration in it, espe- 
cially when the causes of inflammation are so numerous. 
Suppuration in the perinseum, as well as stricture of the 
urethra, are both very liable to follow acute gonorrhoea, par- 
ticularly if it is badly treated, as is too common at the 
present day. Nothing is better calculated to lay a sure foun- 
dation for this disease, than the indiscriminate, stimulating, 
and empirical treatment of acute gonorrhoea, as now usually 
pursued. The most common cause, perhaps, of urinary fis- 
tula is stricture of the urethra. The urethra behind the 
stricture, is always dilated, and sometimes when the patient 



FISTULA IN PERIN.EO— URINARY FISTULA. 243 

is obliged to use much force in expelling his urine, the dila- 
ted portion gives way, and the urine is extravasated into the 
cellular tissue, which gives rise to abscess, and finally fistula. 
Liston observes, " In the gradual escape of urine by ulcera- 
tion, behind the constricted point — the urethra being either 
altogether obstructed, or nearly so — abscess forms in the cel- 
lular tissue, exterior to the ulcerating part. The suppuration 
is often slow in its progress, and imparts to that part of the 
perinseum a stony hardness. Repeated collections of matter 
may form, and if the cause be not removed, numerous open- 
ings will form in the scrotum and perinseum, and through 
them foetid matter and urine will constantly and involunta- 
rily distil. The patient is reduced to a miserable state ; the 
neighboring parts are excoriated, and exhale a noisome 
odor; his body and bed-clothes are soaked and rotted by the 
discharge, and the atmosphere to a considerable distance 
around is very offensive. Fistula in Perinceo is estab- 
lished." — (Liston's Elements of Surgery, hy S. D. Gross, 
M. D.,p. 472.) 

For the other causes of this disease, the reader is referred 
to the chapters on Fistula in Ano and on Abscess. 

The Common Method of Treating Urinary Fistula, 

This disease is very difficult to cure. The spongy body of 
the urethra does not very readily take on the adhesive inflam- 
mation, and the constant passage of the urine through the 
fistulous openings, even independent frequently of the con- 
stant use of the catheter, greatly retards, if not hinders the 
cure. 

The usual means resorted to at the present day for the 
removal of this disease, are the knife, the actual cautery, and 
various caustics. 

Dr. Colles recommends the operation by the knife, to be 
performed in the following manner : " When you cannot 



244: 



FISTULA IN PERIN^EO — URINARY FISTULA. 



introduce the catheter, you are directed to cut down through 
the perineum and urethra on the point of the catheter, to find 
out the impervious part of the urethra, to cut through it, and 
pass on the instrument to the bladder, by the inferior open- 
ing. Now, the great difficulty is to find this opening, or to 
find the urethra at all. I assure you, one of the most expert 
surgeons in the kingdom, was an hour and a half cutting here 
and there, looking for the urethra, and was at last obliged to 
put the patient to bed, without finding it ; the great difficulty 
is to find the urethra. The way I would advise you to pro- 
ceed so as to enable you to come on the urethra, is this : — 
Keep steadily in the middle line — take care that you do not 
let an assistant divaricate the parts as you cut. If he does, 
you will be thrown out of the proper line, and you will be 
cutting in all directions, looking for what you will not find. 
The parts will, indeed, separate but badly of themselves ; 
they will even close on the knife — but do not mind ; cut 
down in the middle line, until you come on the end of the 
catheter. In some cases the presence of the catheter in the 
urethra, hinders the wound in it from closing, and you must 
therefore take it v out, notwithstanding the dread you may 
have of the urethra being very narrow at the seat of the 
wound. The way I am accustomed to finish the operation, 
is this : having come down fairly on the urethra, and cut 
through it, I seek for the lower opening, and pass a small 
sized gumelastic catheter through it into the bladder. 
I then seek the upper opening with a probe, and having 
found it, I just cut off the ivory top of the catheter, and 
introduce the end into the upper perineal opening of 
the urethra, and push it up, or push the urethra down 
on it, until it appears out of the orifice at the glans. I 
then draw the integuments of the wound over it, and leave 
it so." (Oolles 7 Lectures on the Practice of Surgery, j?. 
248-9.) 



FISTULA IN PERINJ30 — URINARY FISTULA. 245 

It should be recollected that the above are the deliberate 
conclusions of an able and experienced surgeon, ooe who for 
thirty-four years was professor of Surgery in the Royal Col- 
lege of Surgeons of Ireland. 

Comment on such a difficult, dangerous, painful and very 
uncertain operation, is unnecessary. He who will submit to 
it, when he might be cured by a mild, safe and most certain 
method, is beyond the bounds of reason and argument, and 
should be let alone. 

I have cured seven cases of this disease within the last ten 
years, one or two of them extremely bad cases. A few of 
their letters I will give below, for the benefit of the reader. 
My motto in the treatment of this, as well as all other dis- 
eases, is, that any treatment, in order to be successful, must 
first be safe. 

Were the causes of this disease well understood, and at an 
early stage well treated, but few cases of fistula in perinseo 
would occur. 

" Great and manifold are the miseries," says an able 
author, " which result from the diseases of the urinary 
organs, and a much more diligent inquiry do they deserve, 
than they have yet met with ; " but as they do not immedi- 
ately belong to my present subject, I must omit, or at least 
defer to another opportunity, entering upon them. This I 
shall do at some future day, in a work about the size of the 
present. 

In the successful treatment of fistula in perina50, the stric- 
ture in the urethra, the induration of the whole neck of the 
bladder, the enlarged and ulcerated state of the prostate 
gland, the disease of the veru montanum, vesiculse seminales 
* and the vasa deferentia, are the great and the principal 
objects of consideration. 



246 FISTULA IN PERIN^O — URINARY FISTULA. 

Letters f Torn Persons Afflicted with Urinary Fistula. 

LETTER I. 

, La., April 2, 1843. 

Dr. Bodenhamer : Dear Sir — I have learned through Mr. T , of 

your State, that you are very successful in the treatment of various dis- 
eases of the lower bowel. I am laboring under a very serious disease, it 
is not however of the bowel, and I do not know whether you treat such 
cases ; it is what is called a fistula in perinaeo. It made its appearance pn 
me just about two years ago, in the form of a small hard lump, at the root 
of the penis, or between the anus and the scrotum. This lump was slow 
in forming j sometimes nearly disappearing, then becoming painful, and 
rising again. I finally consulted my family physician, who advised me to 
poultice it, which I did for six or eight days, and then it was lanced, and 
about half a gill of whitish matter came out, and I thought that I was 
well ; but the place would not heal, and I soon noticed whenever I urina- 
ted, six or seven drops of urine would pass out at the opening. I should 
have told you that T had what my physician said was inflammation of the 
neck of the bladder, about six months before the appearance of the lump. 
Sometimes I suffered with this very much, but since the other disease has 

appeared I am better of this. Last June I consulted Dr. , of , 

who operated on me with a knife. I remained under his care about six 
months, when he sent me home much worse than when I placed myself 
under his care. He advised me to spend the winter in the south, and 
return in the spring, and he would operate again. The cut has but par- 
tially healed, and instead of the few drops that used to ooze out, the urine 
now comes out in a stream. Indeed, about one-half of the urine now passes 
out through this opening. The parts all around have become hard, very 
sore, and excoriated, and my general health is suffering very much. Of 
late, whenever I pass water, 1 have the most severe pain, and shivering 
spells, like the ague, so that I dread very much to urinate. 

The author of the above letter called upon me at Louis- 
ville, Ky., in about two months after the date of his letter, 
and in nine weeks he was perfectly cured, and has remained 
so ever since. I had the extreme pleasure of seeing him at 
the St. Nicholas Hotel, New York, last August, 1854, in per-* 
feet health. It is now eleven years since I cured this gen- 
tleman, during which time I have cured about forty similar 
cases. 



FISTULA IN PERIN^EO — URINARY FISTULA. 247 

LETTER II. 

N. 0., La., Feb. 16, 1844. 

I have now no less than three openings running up into the 

urethra, and the urine comes down through each one of them. My fistula 
was caused by a stricture of the urethra, which I have had for five years, 
and still have as bad as ever. I have had the best surgeons in New York 
and Philadelphia to attend me. I have had the stricture cut and burnt 
with caustic a dozen times, but resulting in no good, and I must have had 
one hundred bougies pushed up. But this fistula alarms me more than any- 
thing else, and I long since determined to die, rather than be cut for it 
with the knife. I reside in the state of New York, but I am on business in 
this city, which will detain me here a few weeks. I will wait here for 
your letter, and if you think you can cure me without the knife, I will visit 
you forthwith. 

This gentleman visited me at Louisville, Ky., four weeks 
after the date of his letter, and was cured in a short time. I 
cured his stricture first, and his urinary fistula afterwards. 

LETTER III. 

C , 0., December 24, 1843. 

Dr. B. : Dear Sir — There is another case of fistula in perinceo in this 
city, one of my friends, a young man about twenty-one years old. He is of 
a scrofulous temperament. There is a tumor at the root of the penis, con- 
siderable soreness and swelling in the whole region. He will find it diffi- 
cult to leave home, as he can scarcely be moved. What shall be done ? 
I suppose that the hope of a cure would stimulate him so much, that he 
would bear the pain and privation of a removal from his father's house. 
Please write, on the reception of this, to Mr. , C , Ohio. 

This young man was brought to Louisville in a few days 
after the date of the above. He was so feeble that he was 
scarcely able to walk. I cured him in a short time. He 
had previously been attended by two eminent physicians 
of C . 



CHAPTER XXIII. 
Vaginal Fistula. 

There are but few infirmities incidental to the female sex, 
more distressing in their nature, and which render the condi- 
tion of their victims more truly miserable, than this unfortu- 
nate and painful accident. 

The vagina may have a communication by means of one 
or more openings with the bladder or urethra, by its ante- 
rior parietis, and with the rectum by its posterior parietis, or 
at the same time, in front and behind, with each of these 
cavities. 

Yaginal fistula then, may be distinguished into three forms: 
vesico-vaginal, urethro-vaginal and recto-vaginal. 

Yesico-vaginal fistula is that form of the accident in which 
an irregular communication exists between the vagina and 
the bladder, through which the urine enters into the vagina, 
and constantly flows out involuntarily. This form, which is 
decidedly the worst, is usually occasioned by the detach- 
ment of a slough, the consequence of long continued pressure 
of the foetal head in the excavation of the pelvis, during dif- 
ficult and laborious labors; by the unskillful use of obstetri- 
cal instruments; by the ulceration from the lodgment of 
foreign bodies in the bladder; by abscesses; by venereal 
ulcerations ; by cancerous ulcers situated on the neck of the 
wt>mb, &c. 

" The situation of vesico-vaginal fistulse," says Professor 
Dieffenbach, " is very various. Tn some cases I found the 



VAGINAL FISTULA. 249 

orifice about one inch behind the mouth of the urethra. 
Sometimes further back ; at other times, finally, as high up 
as the os uteri. They are seldom situate at any great dis- 
tance from the middle line of the vaginal parietes. Kill an, 
Jobert, and several other writers remark, that the accidents 
are more or less severe, according to the situation of the fis- 
tulse. For example : when high up, the urine comes away 
only at times, and when the bladder is very full. However, 
I have always found the patient wet — no matter whether the 
opening was situate low down, in the middle, or very high in 
the vagina. Even the greater or less extent of the orifice 
seems to make little difference. The women were as con- 
stantly wet when the opening into the bladder was not larger 
than the point of a sound, as when it would admit the index 
finger. It is evident, how T ever, the accidents must be greater 
in extensive destruction of the vagina and bladder. 

The inconveniences resulting from vesico-vaginal fistulse, 
are of the most deplorable kind. Those connected with the 
married state, do not require explanation. The constant pas- 
sage of the urine into the vagina, must necessarily produce 
considerable irritation, and even inflammation. The external 
genital organs, the perineum, insides of the thighs, and the 
legs, are exposed to the same injurious actions ; the skin 
assumes a bright red color, and is partially covered with a 
furuncular eruption. The patients complain of a most disa- 
greeable burning and itching sensation, which often compels 
them to scratch themselves until the blood comes forth, and 
thus aggravate their sufferings. Others are obliged to shave 
off the hair from the external organs, which are sometimes 
covered with a calcareous deposite from the urine. Frequent 
washing with cold water is of little avail, since the linen is 
quickly saturated with the fluid which escapes. Position 
also avails little, and the bed, even when consisting of a hair 
mattress, is quickly soaked through, and emits a most disa- 



250 



VAGINAL FISTULA. 



greeable odor. The wretched patients themselves are com- 
pelled to pass their lives on a straw bed, the materials of 
which are changed every day. The air in the chambers of 
such patients acts injuriously on their lungs, and wherever 
they go, they taint the atmosphere. Washing and inunction 
are attended with no advantage. Perfumes only increase the 
disgusting effect of the smell. This unhappy accident breaks 
through all family ties. The most tender hearted mother is 
driven from the society of such an afflicted child ; she is 
confined to a solitary chamber, or sits on a perforated stool 
of naked wood, or a plank, with an open window to the 
apartment, unable to cover the seat with any cloth. Some 
of these unhappy patients fall into a state of indolence ; 
others present a stupid resignation ; while others would 
willingly resign their lives to get rid of the misery which sur- 
rounds them. It is impossible to find any alleviation of the 
accidents by mechanical contrivances. The introduction of 
a sponge, saturated with cold water, prevents the discharge 
of urine for a few hours, in cases where the fistulous opening 
is small. However, the sj>onge soon becomes saturated with 
urine, and produces disagreeable sensations, which render it 
insupportable to many females. All attempts at filling the 
vagina, and thus preventing the influx of urine, have failed. 
The different contrivances for receiving the urine which 
flows into the vagina, are also equally useless, and I have 
seen many cases in which they aggravated the evil instead 
of relieving it." {Physiological Views relative to Vesico- 
vaginal Fistula, <&c. London Lancet, August 27, 1836. 
From Berlin Med. Zeit, June, 1836.) 

Urethro-vaginal fistula is that form of the accident in 
which a preturnatural communication exists between the 
vagina and the urethra. This form is not so bad as the pre- 
ceding, because the urine does not flow usually except dur- 
ing the voluntary expulsion of this fluid, which escapes partly 



VAGINAL FISTULA. 251 

by the accidental perforation. It may be produced by the 
same causes, which produce the former. 

Recto-vaginal fistula is that form of the accident in which 
a fistulous passage communicates between the vagina and the 
rectum. This accident is usually the result of laceration of 
the septum, between the vagina and the rectum, by the rash 
use of instruments, or by tearing in the natural efforts of 
parturition. In the latter case, the perinseum usually suf- 
fers laceration also, or by the opening of abscesses in the 
direction of the two passages, &c. In such cases the faeces 
when solid, are expelled, in part, through the vagina, and in 
part, through the anus ; but only during defecation. When 
the faeces are fluid, however, they and the intestinal gases 
escape involuntarily through the fistula, and pass out by the 
vulva. 

This form of the disease appears to be common among 
prostitutes, in consequence, it is believed by some, of the 
recto-vaginal wall being exceedingly thin in such characters. 
In about four thousand prostitutes in Paris, says Mons. 
Duchatelet, there occur annually about thirty cases of recto- 
vaginal fistula ; and strange to say that they sometimes heal 
of their own accord, while these patients are pursuing their 
ordinary avocations. These fistulas were generally found to 
co-exist with phthisis. (De La Prostitution Dans La Ville 
De Paris. By Mons. Parent Duchatelet, M. D.) 

Some of the Methods of Treating Yesico- Vaginal Fistula. 

Yesico-vaginal fistula has doubtless existed at all periods ; 
yet strange to say, that no good history of it can t be found, 
and it has only been since the commencement of the present 
century, that it has at all attracted the attention of surgeons. 
It is to be hoped, therefore, that the importance of the sub- 
ject will not fail to excite the sympathies of all who under- 
stand its nature, in causing them to use every exertion in 



252 VAGINAL FISTULA. 

their power to alleviate the condition of those who are its 
victims ; always remembering that they are Heaven? s test 
gift to man. 

It is admitted by all that the treatment is attended with 
the greatest difficulty. In fact it is seldom ever cured. This, 
on account of the unfortunate sufferer, has always been a 
matter of the most profound regret.* 

A most savage operation for vesico-vaginal fistula is now 
performed and advocated by some of the French surgeons — 
it is nothing more nor less than an attempt at the complete 
obliteration of the vaginal canal. If this operation could 
ever succeed in curing the disease, and if there was no other 
method less objectionable, then perhaps the adoption of it 
might be countenanced. The following extract from Bank- 
ing's Medical Abstract for July — December, 1845, pages 
196-7 gives the modus operandi. 

" J. L. Petit shrank before the difficulties of any attempt 
to cure this disease when there was considerable loss of sub- 
stance ; but since the publication of a memoir by Lalle- 
mand, in 1825, the first surgeons in France have made 
efforts to cure it. Among these may be cited Desault, 
Dupuytren, Mallagodi, Roux, Velpeau, and "Vidal, but with 
very little success. Many have denied that a cure has ever 
been obtained ; nevertheless M. Jobert is said to have per- 
formed seven operations of an autoplastic nature, to which 
he has applied the term elytroplasty, with more or less suc- 
cess. We have given a very interesting case of this disease, 
(Abstract, Art. 67,) in which the last mentioned surgeon, 

* I take pleasure in stating that Dr. J. Marion Sims, formerly of Alabama, but 
now of this city, (New York,) has invented a method of curing vesico-vaginal 
fistula, which is said to be uniformly successful. I have not the pleasure of an 
acquaintance with Dr. Sims ; neither do I know any thing in relation to the par- 
ticulars of his method — yet I have every reason to believe that it is as repre- 
sented. 



VAGINAL FISTULA. 253 

having failed in his usual method, adopted a new one with 
complete success. 

"In a report by M. Yidal, (Ann ales de la Chirurgie, 
May, 1845,) of a discussion at the Boyal College of Medi- 
cine, we obtain the particulars of a case operated on by M. 
Berand, by the method of infibulation or obliteration of the 
vagina. The principle of this method, is to abandon the per- 
foration in the bladder, and to unite the vulva, so as to oblit- 
erate the vagina, and to form, with its posterior parietes, a 
new fundus to the bladder. The case was an enormous fis- 
tula, in which not only the vesico-vaginal partition, but the 
posterior part of the urethra was destroyed. M. Berand 
made an elliptical incision round the vagina, behind the 
nymphse, from the meatus above to the commissure below. 
The posterior edge of the incision was taken up with forceps, 
and the mucous membrane dissected off, two centimetres 
above and three below. It then formed a diaphragm, adhe- 
rent by its large circumference, and pierced with an oval 
opening, presenting an external bleeding surface, and an epi- 
thelial surface towards the vagina. A suture (a point passe,) 
was passed round the small circumference, the two ends of 
the thread being left pendent in the vulva. Then a catheter 
(sonde de Belloc,) introduced by the urethra, was passed 
through the fistula, and brought out by the small circumfer- 
ence. The two ends of the ligature were fixed upon this, 
and drawn back by it through the urethra. The catheter 
was then replaced by an elastic gum bougie, intended to 
facilitate the flow of urine, and to give attachment to the 
thread. This was fixed firmly. On drawing the threads the 
circumference of the diaphragm was drawn, like the mouth 
of a purse, backwards, presenting the aspect of a hollow 
cone, which could be tightened so as to close the aperture. 
The surfaces of the mucous membrane, from which the cir- 
cular diaphragm was detached, were drawn together, and 



254 VAGINAL FISTULA. 

maintained in contact by suture. The obliteration of the 
vagina was not complete, and the patient died of peritonitis 
about six weeks after the operation. 

Numerous objections to this operation were brought for- 
ward. Among the rest, the impossibility of obtaining a 
complete occlusion of the vagina — the difficulty of the ope- 
ration — the retention of the menses in early life — the pre- 
vention of the performance of the sexual functions — and the 
danger of peritonitis and purulent absorption. M. Berand 
remarked, in reply, that a woman with a large and deep 
vesico-vaginal fistula, the urine flowing without cessation, 
and irritating the vagina and vulva ; the buttocks and thighs 
irritated ; the patient exhaling an insupportable odor ; the 
sexual relations prevented ; the disgust inspired ; her suffer- 
ings casting her into despair ; urging her to suicide, or lead- 
ing to inevitable death — the case incurable by all known 
means, — under these circumstances, he retains his favorable 
opinion of the operation for the obliteration of the vagina. 
In the case in question, the patient was doing well to the 
twenty-third day, when an inflammatory attack occurred 
from cold, and she died seventeen days afterwards. On dis- 
section, the vulva was found nearly obliterated, two small 
openings only existed, superiorly and inferiorly ; the latter 
communicating with the vagina and the former with the 
bladder." 

The following goes to prove that vesico-vaginal fistula 
may sometimes be cured by very simple means. 

" During the time not yet very remote, when it was sup- 
posed that the cure of vesico-vaginal fistula was always 
beyond the resources of art, and especially that it was useless 
to attempt the radical cure, by means of a surgical operation, 
the palliative mode, which was generally employed with the 
sole view of diminishing the inconveniences of a disgusting 
infirmity, was sometimes found to be successful in the cure 



VAGINAL FISTULA. 255 

of the patient. Fabricius Hildanus, who died at Berne, in 
1634, relates a complete cure obtained in this way, in a lady 
affected with a vagino-vesical fistula, following a laborious 
labor. According to this celebrated author, the cure was 
obtained by a treatment of eight months duration, which 
consisted simply in the use of some purgative doses, and of 
frictions upon the loins, but especially in the frequent 
employment of injections, composed of a decoction of bar- 
ley, of quince seeds, and the seeds of the fenugreek, (trigon- 
ella, fcenum grgecum,) to which he added oil of sweet 
almonds and honey of roses. We subjoin, moreover, the 
most important passages from this curious case : " Ilia autem 
continuo usa medicamentis (ut dixi) conglutinantibus, et per 
intervalla etiam purgantibus, intra menses octo, non sine 
admiratione omnium eorum quibus res cognita plane curata 
fuit, adeo ut nunc Dei optimi maxima gratia ne guttula qui- 
dem urinse involuntarise affluat, sed a vesica colligatur, reti- 
neatur et excernatur non aliter ac si antea nunquam male 
aftecta fuisset." — (Colomlat on Diseases of Females, p. 
244-5.) 

My success in the treatment of these sad accidents, so far, 
has been complete, having had but four cases, and having 
perfectly cured each one. One was a case of vesico-vaginal 
fistula, and three were cases- of recto- vaginal fistula. Two 
were married ladies, and mothers. They both have had chil- 
dren since they have been cured, and are now both doing 
well. In one of these, the accident was caused by a lacera- 
tion during a difficult labor, in the other it was caused by an 
abscess in that particular vicinity. 

The following letters will be explanatory of the case of 
vesico-vaginal fistula alluded to. 

, Ky., May 21, 1841. 

Doctor Bodenhamer : — Dear Sir — From what I know of your success 
in the treatment of a certain class of diseases, I have for the last six months 
been using my utmost endeavors to induce my sister-in-law, Miss , 



256 VAGINAL FISTULA. 

who resides with me, to consult you for a most loathsome complaint which 
she has been laboring under for the last eighteen months. Such has been 
her reluctance to undergo an examination and treatment, that she had 
determined to linger out a miserable existence rather than submit. This 
morning, however, she consented, for the first time, to let me give a state- 
ment of her case, and at least get your opinion of it. She has taken a 
great deal of medicine, but she has never been examined by any physician. 
About one year before this disease came on she labored under some disease 
of the bladder, at least such was the opinion of her physician. She most 
always felt a dull, heavy pain about* the bladder, extending to the back, 
hips, and down the thighs, attended by a difficulty in urinating, and a con- 
stant desire to do so. All this time, everything was done, that could be, to 
relieve her, but without doing any good. Her general health continued to 
decline, until she was scarcely able to walk across the room. One day as 
she was coming down the stairs, she felt something break loose near the 
bladder, and immediately there was a discharge of about half a pint of thin 
dark colored and very offensive matter. This she always believes came 
from her bladder. Since this has taken place, she suffers scarcely any of 
her old pains; but what is much worse, there is a constant dropping of 
urine both day and night, so much so that she has constantly to keep fresh 
clothes applied. The smell is also so very offensive, that she now has a 
room to herself, and scarcely sees any one. There is no discharge of mat- 
ter now, as far as she knows. Her general health is better than it was 
previous to the appearance of the disease, but I discover lately that she is 
getting worse again. She appears quite melancholy and desponding, 
indeed she has entirely changed in every respect. Her age is twenty-four, 
and she has never been married. 

, Ky., December 23, 1841. 

Dear Doctor — According to promise, 1 now write you again. Miss 

continues well; indeed I consider her entirely cured. She can 

scarcely realize it herself, and has until a few weeks always been imagin- 
ing that she might not be entirely well, or anticipating that the disease 
might return. However, within the last two weeks she has changed very 
much in this respect, and she is now as cheerful as she ever was, and in as 
fine spirits. To give you some idea of her zeal in your behalf, a few days 
ago, she made me take her in the carriage some twelve miles to see a lady, 
a stranger to us, who she heard had a disease like her own, in order to pre- 
vail on the lady to visit you immediately. It proved however to be a dif- 
ferent disease. 

This young lady continued well up to the fall of 1843, 
when she married, and left Kentucky. She wrote me in the 
spring of 1845, that she was in perfect health. 



VAGINAL FISTULA. 257 

A full report of these cases of vaginal fistulge together 
with the treatment, will be given in my forthcoming work 
on the genito-urinary organs. 

Since the preceding chapter was written in 1846, 1 have 
successfully treated five additional cases of recto-vaginal fis- 
tula. Now 1854. 



THE END. 



17 



TESTIMONIALS. 



The following commendatory notices have reference to the First Edition of this 

Work (1847). 

The Publishers of Bodenhamer's work on Anal and Rectal Diseases, are 
much gratified at being able to furnish the following, a few of the numerous tes- 
timonials of approbation which have thus early come to hand. When this work 
first appeared, it had to encounter much deeply rooted prejudice,, on account of 
its not containing the peculiar treatment of the author, &c. In spite, however, 
of these obstacles, its reception has been truly flattering ; and many of those who 
were at first prejudiced against it, are now acknowledging the practical information 
they have derived from its perusal. 

The author has devoted several years to the study and treatment of this class of 
diseases ; and it is admitted that where the mind is wholly devoted to any one 
object, with talent and perseverance, excellence must ultimately be attained. He 
has truly invaded this difficult and disagreeable province of Surgery, and made it 
his own by conquest. The work is decidedly a desideratum, and should be in the 
hands of all to whom it is addressed. 

From the Southern (New Orleans) Literary Advertiser, January, 1847. 

" Practical Observations on some of the Diseases of the Rectum, Anus, and Con- 
tiguous Textures ; giving their Nature, Seat, Causes, Symptoms, Consequences, 
and Prevention ; especially addressed to the non-medical reader By W. Bo- 
denhamer, M. D." Printed for the Publishers, A. G. Sparhawk, Cincinnati. 
J. B. Steel, New Orleans. 

The subject on which Dr. Bodenhamer treats is one coming home to the feel- 
ings of perhaps three-fourths of our adult population. The diseases affecting the 
rectum and contiguous parts, such as piles, abscesses, fistula, are far and wide 
spread, and the physician who can devise a system of effectual prevention and 
cure to these tormenting visitations, often fatal in their results, well deserves the 
thanks of humanity at large. The observations which the author here publishes, 
seem founded on diligent research, and much scientific knowledge ; and the testi- 
monies which accompany them, being letters from his patients, whom he has 
relieved, go far to prove that his method of treatment is eminently successful. 
We perfectly concur with the learned Doctor, in his denunciation of the pernicious 
habit of taking drastic medicines, for the least constipation. They are, in nine 



2 TESTIMONIALS. 

cases out of ten, with both sexes, the causes of the disagreeable complaints of 
which he treats. Fathers of families would do well to provide themselves with a 
copy of this work. 

From the New Orleans Delta, February 5, 1847. 
Bodenhamer on Anal and Rectal Diseases. — This is a medical work of 
much usefulness, especially designed for the information of non-medical readers. 
The author is W. Bodenhamer, M. D., of Louisville, Kentucky ; at present a 
practitioner in this city. It is for sale at J. B. Steel's, 14 Camp-street. 

From the Vicksburg Whig, December 31, 1846. 
Dr. Bodenhamer. — We have rec3ived from this gentleman, through a friend 
in this place, a work on many diseases, some of which we know are not less 
numerous here than in some other places. The work is addressed to the non- 
medical reader, showing the manner in which all the diseases spoken of are 
brought on, and how they may be avoided. The Doctor does not give the cures, 
and his reasons are certainly good. In the first place, he is opposed to publishing 
cures for the multitude ; and secondly, he believes that persons treating diseases 
should have a full and complete knowledge of the anatomy and physiology of the 
parts concerned. He will, however, at some future time, address a work of the 
same character, more full in detail, in which will be embraced his treatment. This 
work certainly demands the attention of those to whom it is addressed, as there 
are indubitable proofs of the efficiency of the author contained in the work. Be- 
sides, the estimation in which the Doctor is held by one of our Levee merchants, 
will be sufficient for any one in our city to know, as evidence that there is no 
humbug about the work. It may be had at Sale & Creecy's. 

From the May smile {Kentucky) Eagle, June 5, 1847. 

Bodenhamer on Anal and Rectal Diseases. — The author of this work, to 
whom we are indebted for a copy, Dr. W. Bodenhamer, formerly of Paris, but 
for several years past engaged in practicing medicine in Louisville and New Or- 
leans alternately, is known either personally or by reputation to many of our 
readers. This work, which he designs following by one more comprehensive for 
the profession, was written for the public, and is divested, as far as may be, of the 
technical language that bewilders the unskilled in medical reading. It is thorough 
and practical, and the nature and frequency of the diseases treated of will make 
it highly acceptable to every unfortunate sufferer. The work is for sale at the 
Eagle Book Store. 

From the St. Louis Republican, July 8, 1847. 

A New Work, which has recently been published in Cincinnati, and may be 
found at the bookstore of W. D. Skillman, on Fourth street, in this city, promises 
to attain very general celebrity. It treats of a class of diseases now very common 
in this country, affecting the lower viscera, and for which caustic and very harsh 
remedies have been attempted, in most cases without affecting positive cures. The 
author of the work is Dr. W. Bodenhamer, and it is "especially addressed to 
the non-medical reader," and is so free from the technicalities of the science as 



TESTIMONIALS. . • 3 

to be easily understood. The book is interspersed with hundreds of cases, stated 
by the sufferers, in which cures have been effected, by adopting the mode of prac- 
tice suggested by Dr. Bodenhamer ; and it is reasonable to suppose that others, 
laboring under similar diseases, will at once seek the remedy which he holds out 
to them. Dr. Bodenhamer is a resident of Louisville. 

From the Pittsburgh Christian Advocate, June 23, 1847. 
Bodenhamer on Anal and Rectal Diseases. — This is a most valuable book 
for the non-medical reader — for to such it is addressed. If he is not afflicted 
with any of the horrid diseases treated of in the work, it may be the means of 
prevention. If he is afflicted, we would advise him to go immediately to Dr. 
Bodenhamer, whose mode of treatment is without cautery or knife, but bland, 
safe, and almost certain. We are acquainted with a gentleman in this city who 
suffered for twenty years, and was cured in a very short time by Dr. Bodenhamer. 
Hundreds have applied to him and have been cured. The above work is for sale 
by J. L. Read, 4th street, near Market. 

From the Nashville Orthopolitan, September 15, 1847. 

Messrs. Graves and Shankland have laid upon our table a volume entitled — 
" Practical Observations." This work treats of diseases of the most painful cha- 
racter, " giving their nature, seat, causes, symptoms, consequences, and preven- 
tion ;" and it is especially addressed to the non-medical reader. The author, W. 
Bodenhamer, is a practicing physician, and his book is written in plain and un- 
derstandable language ; it is not rendered unreadable by technicalities. We think 
this book well calculated to do good. It may be had of Graves & Shankland, 
Union-street. 

From the Louisville (Kentucky) Democrat, December 8, 1846, 

Bodenhamer on Anal and Rectal Diseases. — This work has just been 
issued from the press, and is now offered for sale by J. Maxwell, Jr., and F. W. 
Prescott & Co., to whom we are indebted for a copy. The author has acquired 
great celebrity in the treatment of this class of diseases — is unequaled in our 
country. The book is especially addressed to the non-medical reader, but doubt- 
less it will find its way in numbers to the hands of the profession. 

From the Louisville Journal, December 8, 1846. 

Bodenhamer on Anal, and Rectal Diseases. — The author of this work has 
devoted himself for years, with unrivalled success, to the cure of the diseases 
which are the subject of the volume. It is doubtless a valuable work For sale 
by J. Maxwell, Jr. 

From the St. Louis New Era, July 7, 1847. 

Mr. Skillman has sent us a work by Dr. Bodenhamer, being H Practical Ob- 
servations " on certain diseases of the lower viscera, in the cure of which this 
gentleman seems to have been eminently successful. The diseases in question 
are very common in the South and West, and are frequently the result of the 
ordinary medical treatment of these regions. They have hitherto been managed 
with caustic and the knife — but Dr. Bodenhamer uses neither. He thus not only 



4 TESTIMONIALS. 

relieves his patients from very troublesome and painful maladies, but saves thern 
from a butchery, which often fails of a cure. Doing this, as it would appear he 
does, he is a benefactor in a double sense ; and it is only desirable that his method 
of treatment should be universally known, so that it may be universally followed. 

From the St. Louis Reveille, September 21, 1847. 
Pleasing Intelligence for the Afflicted. — We learn from a friend who 
has recently been under the medical care of Dr. Bodenhamer, of Louisville, that 
this eminent physician purposes to spend the month of November in this city. 
His skill and astonishing cures in diseases of the rectum, fistula, piles, &c, has 
built for him a well merited reputation throughout the South and South- West ; 
and as these afflictions are very prevalent in this region, we know that we do 
those afflicted a service in imparting the above information. Dr. B.'s work upon 
the cause of these diseases, should be used by every reader ; for it imparts lessons 
which would serve to protect them from such maladies. He argues, and we 
unhesitatingly agree with him, that the recklessness with which people use dras- 
tic purgatives upon every slight cause of ailment, is the chief source of those 
afflictive diseases. 

From the New Orleans Picayune, December 29, 1846. 

" Practical Observations on some of the Diseases of the Rectum, Anus, and Con- 
tiguous Textures ; giving their nature, Seat, Causes, Symptoms, Consequen- 
ces, and Prevention ; especially addressed to the non-medical reader. By W. 
Bodenhamer, M. D." 

Such is the title of a work which we have received from the author, accompa- 
nied by numerous testimonials from gentlemen of character as to the Doctor's 
general skill and intimate familiarity with the particular class of diseases of which 
his work treats. We would especially call the attention of all interested to this 
valuable work. It is for sale at the Book Store of J. B. Steel, 14 Camp-street. 

From the Western (Paris, Kentucky) Citizen, June 18, 1847. 

Dr. Bodenhamer. — We advertise in another column anew medical work, from 
the pen of Dr. Bodenhamer, formerly of this place. Our community are so 
familiar with the success of Dr. B. in the diseases of which his work treats, that 
it is entirely unnecessary for us to commend it to public attention. 

From the Pittsburgh Protestant Unionist. 

" Practical Observations on some of the Diseases of the Rectum, Anus, and Con- 
tiguous Textures ; giving their Nature, Seat, Causes, Symptoms, Consequen- 
ces, and Prevention ; especially addressed to the non-medical reader. By W. 
Bodenhamer, M. D., Louisville." 

Dr. Bodenhamer is personally known to us, and is one of our brethren. He 
is a very estimable man, and withal, the most famous practitioner in that class 
of diseases, in relation to which this book is written, that exists in the East, 
West, or perhaps any other country. We know no physician who has attained 
to. an equal celebrity in this respect with Dr. Bodenhamer. 



TESTIMONIALS. D 

The reader's attention is now called to the following, a few of the very numer- 
ous testimonials which the author has in his possession, relative to the uniform 
success which has attended his peculiar practice in the treatment of the diseases 
named in this work. 

From the Western Citizen, Extra, of January 15, 1841. 

We issue a small extra sheet this day, containing the Card of Dr. Bodenhamer, 
and the testimonials of a number of gentlemen, who have been cured by him. 
We take pleasure in adding our testimony to the success which has attended Dr. 
B's. practice in those diseases. Several of the gentlemen, whose certificates 
accompany his card, are our personal acquaintances, and others are known to us 
from character, and from a partial acquaintance, while here under Dr. B.'s care, 
and we take great pleasure in stating that the utmost reliance can be placed upon 
these statements. 

Dr. B. has been eminently successful in his treatment of those diseases as our 
whole community could testify, and is excited by a laudable spirit, in endeavoring 
to place the facts before all, who may labor under their sufferings. 

We send forth this " little extra," with the hope that it will prove " glad tidings 
of great joy" to many who are laboring under those the most painful and loath- 
some diseases " which flesh is heir to." 

We may add, that ours is a pleasant little town, in a rich and beautiful country, 
and its health, locality, accommodations, and all combine to render it just such a 
place, as a stranger would like to tarry at for a while. 

We notice in the Louisville Journal, of August 31, 1840, the following para- 
graph : — 

" On Friday we noticed the arrival of Dr. Bodenhamer, distinguished for his 
novel treatment of a certain painful disease without the use of the knife. Dr. B. 
has since exhibited to us the most satisfactory testimonials of his success, from 
persons well known to the public." 

Also the folloicing from the same, of March 22, 1842 : — 

'• Messrs. Editors : Feeling well assured that you are disposed to publish any 
thing calculated to benefit the afflicted, and subserve the interests of science, I 
would respectfully ask a brief space in your extensively circulated paper, in order 
to call the attention of all those afflicted with diseases of the rectum and anus, to 
the card of Dr. Bodenhamer. * He is now at the Gait House, and intends remain- 
ing there for a few days, as I am informed. The class of diseases to which he 
has given his most particular attention, and in which he has had a most extensive 
practice, embraces some which are perhaps as distressing in their nature, and 
which render the condition of their victims more truly miserable, than perhaps 
any other to which human nature is liable. The unparalleled success of the Doc- 
tor's peculiar method of treating these diseases, has attracted to his residence (at 
Paris, Ky.) patients from different sections of the Union, and also secured to him 
a very enviable reputation. We would advise all persons laboring under any of 
these diseases, to avail themselves of the present opportunity of seeing and con- 
sulting the Doctor whilst he remains in the city. D. F****." 



6 TESTIMONIALS. 

From the Louisville Journal, May 24, 1843. 

In publishing Dr. Bodenhamer's card, we feel that we are doing a public ser- 
vice by calling attention to it. Dr. B. called upon us a few days ago and exhib- 
ited to us his case of instruments, which greatly surprised us by their variety and 
singular ingenuity. We can venture to say from the facts and testimonials before 
us, that there are few cases of the diseases which he professes to treat, that he 
does not cure perfectly, speedily, and without the infliction of pain. 

The following is from Dr. Thomas, formerly of Richmond, Va., but now of Mott 
Haven, N. Y., Editor of " The Herald of the Future Age." 

The man, who by any discovery in the treatment of diseases, especially of sur- 
gical diseases, can diminish the intensity of human suffering, richly deserves the 
title of Euergetes, or Benefactor of his race. In the treatment of fistula in ano 
et perineo recourse is generally had to the knife, which is always painful, often 
hazardous, and frequently unsuccessful. These results are the invariable con- 
comitants of the popular practice. We feel pleasure, however, in announcing to 
the public, that those afflicted with the diseases mentioned in Dr. Bodenhamer's 
card, may, if they will embrace the opportunity, confer upon themselves much 
happiness, by placing themselves under his treatment, which consists not only in 
treating but curing these diseases. We have seen many drawings of cases which 
have been cured by Dr. B. Several of these had been previously operated upon 
twice or more times with the knife, but without a curative effect ; thus superadding 
to the misery of the disease, intense suffering from useless incisions. Dr. B.'s 
principle of cure is a strictly scientific one ; it is a principle adopted by all edu- 
cated practitioners in the treatment of numerous surgical cases ; and one, in^rief, 
without which they could do nothing. From frequent conversation with the Doc- 
.tor, we have been enabled fully to comprehend his treatment, and have no hesita- 
tion in saying, that were it submitted to the judgment of the Royal' College of 
Surgeons in London, Dublin, or Edinburg, they would pronounce it perfectly 
scientific, and the apponent of it to practice as worthy of all praise. 

For ourselves, there is nothing we despise so cordially as quackery in any 
department of human knowledge or ingenuity. We can assure the public, there 
is none in the pretensions of Dr. Bodenhamer. The cases he has cured, as the 
Editor of the Louisville Journal says truly, " without the infliction of pain," will 
speak for themselves. The doctor has cases from the remotest parts of the Union, 
who come to him, and board in Louisville, for the sole purpose of being under his 
care, upon the recommendation of others, who have been made whole by his 
instrumentality. For one thing we cannot but blame him, namely, that he is too 
diffident — a fault, however, if indeed it be one, the almost invariable accompaniment 
of true merit. We think he ought to advertise his card in the principal journals 
of the Atlantic Cities, inasmuch as he is fully competent to confer substantial 
benefit upon the afflicted as well as upon himself. Hitherto, we believe, he has 
depended chiefly on the recommendation of the individuals he has cured. 

JOHN THOMA*S, M.D. 
Louisville, Ky., June, 1844. 



TESTIMONIALS. 7 

From the Louisville Tribune, July 5, 1844. 

We would direct especial attention to the documents contained in Dr. W. 
Bodenhamer's advertisement on our first page. He has been prompted to the 
publication of them by his friends, who consider him as pre-eminently entitled to 
public consideration and confidence, not only in the treatment of perineal,, anal 
and rectal lesions, but also as a physician in general. 

The following is from " The Protestant Unionist," Pittsburg, Pa. 

Medical. — Perhaps from no other class of diseases, is more suffering experi- 
enced, than from those affecting the rectum. None are perhaps more difficult to 
treat successfully, and certainly there are none in which a rational treatment is 
more necessary. Of the practitioners who have directed their skill and genius to 
the cure of these diseases, no one has attained to greater celebrity than Dr. W. 
Bodenhamer, of Louisville, Ky. In the Louisville Tribune, Extra, Dr. B. says : — 
" Too many patients are said to have been cured by operations that have ultimately 
failed. Those bloody beacons, like the false lights of wreckers, have blazed but 
to betray, and the surgeon and the patient have often been lured on by their lying 
lustre to perform and to submit to barbarous repetitions of equally unsuccessful 
butchery. It should, therefore, be the great object of surgeons to discountenance 
these barbarous practices. To this point mainly our humble efforts have been 
directed." 

The following icas received from the Hon. Richard M. Johnson, whilst he was 
Vice President of the United States. 

My Dear Sir : — This will be handed you by Dr. Bodenhamer, who wisb.es to 
make some publication in the Globe, relative to a certain class of diseases which 
he treats with the most astonishing success. Permit me, therefore, to recommend 
him -to you as a gentleman of real merit, and in every respect worthy of confi- 
dence. I solicit for him your kindness and friendship. 

I am very respectfully yours, 
F. P. Blair, Esq., R. M. JOHNSON. 

Editor of the Globe, Washington, D. C. 

The following is from " The New Orleans Picayune," of January 24, 1846. 

Dr. Bodenhamer, whose advertisement will be found in another column, comes 
recommended by letters from the most respectable gentlemen, professional and 
otherwise, of the West. They speak of him as eminently successful in the 
branch of his profession to which he has given particular attention. 

The following is from -Samuel P. Weisiger, Esq. His case is alluded to, in 
another part of this work. 

Gentlemen — This will be handed to you by my friend, Dr. Bodenhamer, of 
this city. He visits New Orleans for the purpose of spending a few months, and 
practising his profession. The Doctor treats the piles and fistula with great suc- 
cess ; he having treated my case, (after having suffered greatly for more than 
eight months,) and giving me relief in a few weeks. I can, therefore, recommend 



8 TESTIMONIALS. 

the Doctor to any of your friends who may be laboring under a similar affection. 
Any aid rendered, or attention shown the Dr., will be gratefully acknowledged. 

Respectfully yours, &c. 

SAM'L. P. WEISIGER. 
Messrs. Worsley, Foreman & Keneday, 

Commission Merchants, New Orleans, La. 
Louisville, Jan. 1, 1846. 

' The following is from W. Bishop, Esq., proprietor of the Louisville Hotel : — 

Dear Sir — Permit me to introduce to your acquaintance and friendly atten- 
tion, my friend Doctor Bodenhamer, of Louisville. It is the Doctor's intention to 
practice his profession in your city for a snort time. Here he stands very high in 
a particular branch of his profession. Any attentions or civilities extended to 
him, in aiding the object of his visit, will be thankfully acknowledged by 

Your friend and humble servant, 

W. BISHOP. 
N. P. Wood, Esq., New Orleans, La. 
Louisville, 8th January, 1846. 

The following- is from my friend L, H. Mosby, M. D., late Post Master of Louis- 
ville : — 

Dear Sir — Although I have not the pleasure of a personal acquaintance with 
you, it has been my good fortune to have corresponded and co-operated with you 
in the Post-office service. I hope you will then excuse the liberty I am taking in 
introducing to your acquaintance Dr. Bodenhamer, a practitioner of medicine in 
this place. 

Dr. B. has for many years given his particular attention to the treatment of the 
diseases of the rectum ; and I certainly regard him as decidedly the most success- 
ful practitioner in that department of the profession, that I have ever known. I 
therefore do most cordially recommend him to any of your friends or acquaintan- 
ces who may need his aid. 

I suppose you may have heard that I have had to " walk iheplank' 1 '' — and have to 
return to the practice of my profession — and which, by-the-by, I had better never 
have left. 

I am truly and respectfully, 

Your unknown friend, 

L. H. MOSBY. 

Gen. W. De Buys, New Orleans, La. 
Louisville, Ky., January 3, 1846. 

From the New Orleans Delta, Jan. 1, 1850. 

Dr. Bodenhamer. — This gentleman, who resides at Louisville, Kentucky, is 
now on a professional visit to our city, where he will remain till the 1st of April 
next. Dr. Bodenhamer has a great reputation for treating diseases of the rectum, 
curing fistula, &c , as present testimonials of success from some of the most con- 
spicuous citizens in our city, as well as in the west, testify. His method is said 
to be remarkably mild, safe and certain. Hundreds of persons in the west rejoice 



TESTIMONIALS. 9 

in cures of these horrible diseases, effected by the science and skill of Dr. Boden- 
haraer. His residence is at the St. Charles Hotel. 

From the Louisville Democrat, August 19, 1850. 

We had the pleasure of seeing a few days ago, at Mr. Beard's jewelry store, an 
elegant silver pitcher, of beautiful workmanship, belonging to Dr. Bodenhamer. 
It was lately presented to him by Dr. Williamson, a planter of Louisiana, as a 
token of gratitude to the Doctor for having relieved the donor entirely of a most 
inveterate and painful disease. Dr. B.'s eminent success in treating diseases of 
the same class is well known, and such testimonials are creditable to him that 
gives and him that receives. 

From HaWs Journal of Health, New York, May, 1854. 

No educated physician in the West and South- West has had so extensive and 
successful a practice in these painful diseases as Dr. Bodenhamer. His wide 
reputation has secured him patients from every portion of the United States, and 
his forthcoming work will doubtless be an important addition to the Literature of 
the profession. It is to be hoped that it will not long be delayed. 

The distinguishing feature in Dr. B.'s treatment of these diseases is, that caute- 
ries and the knife are not employed. 

Dr. Bodenhamer has been earnestly solicited, for some years past, by northern 
gentlemen, to locate in the north, where a wider and more remunerative field 
would be opened to his skill. He has at length determined to do so, and become 
a resident of New York, where he is expected to arrive during the present 
month. 

From HalVs Journal of Health, New York, June, 1854. 

It is announced that Dr. Wm. Bodenhamer, formerly of Louisville, Kentucky, 
has become a citizen of New York. This gentleman has been distinguished for 
many years in the west and south-west, for the successful treatment of a class of 
diseases which are far more prevalent than most persons are aware of ; to wit, 
Piles, Strictures, and Fistulas of all descriptions. Formerly, these ailments were 
cured by cauteries or the surgeon's knife — always painful and sometimes danger- 
ous to life, besides not always efficacious. Many cases are reported in medical 
journals, where several operations have been necessary. Dr. B. does not employ 
the knife, nor does he use cauteries of any kind, but cures by a method detailed 
in his forthcoming work, (through the Messrs. Woods of this city,) and which, in 
most instances, does not confine the patient to his house, nor detain him from his 
ordinary business. 

From Geo.W. Johnson, of New Orleans, May 1, 1854. 

Dear Brother — Dr. Bodenhamer, under whose treatment I have already de- 
rived great benefit, and anticipate a perfect cure of my present, as well as past 
maladies, visits New York to establish himself professionally there. 

Should any of your acquaintances be suffering from any disease of the lower 
intestines, as ulceration, piles, fistula, fissure, &c., you will confer a benefit upon 
them in commending them to the Doctor, whose skill and successful treatment has 



10 TESTIMONIALS. 

restored to perfect and permanent health many persons with whom I am personally 
acquainted, and whose appreciation of the Doctor's merits are as warm as my own. 

The Doctor will leave his card for me, as soon as he has selected a location. I 
trust to be on earlier with you than usual this summer, to follow up the benefit 
already derived. Your affectionate brother, 

GEO. W. JOHNSON. 

Bradish Johnson, Esq., New York. 

From HalVs Journal of Health, New York, September, 1854. 

W. Bodenhamer, M. D. — The Card of this gentleman will be found below 
Having known the Doctor for a number of years, and the singular success attend- 
ing his peculiar practice in the diseases ramed in his card, it affords us great plea- 
sure to add our own testimony to that of the following, from the two leading 
journals of Louisville, Ky. 

From the Louisville Journal, May 30, 1854. 

Dr. W. Bodenhamer, a distinguished gentleman in his prof ession, from Louisville, 
Ky., has settled in our city, and has rooms at the St. Nicholas Hotel, Office, 37 
Irving Place. Dr. B. is well known throughout the South and West for the suc- 
cessful and skillful treatment of diseases mentioned in his card. — New York Na- 
tional Democrat. 

It seems from the notice above that Dr. Bodenhamer has established himself in 
the city of New York. ( We cannot commend him too strongly to the people of 
New York city, and of all that section of country. He has devoted about fifteen 
years in Louisville and New Orleans, to the treatment of the diseases named in 
his card, and we have always understood that, in the cure of these diseases, he is 
wholly without a rival anywhere. We know that he has treated not only hun- 
dreds but thousands of aggravated cases, and we are assured that, in every 
instance, he has succeeded in effecting a perfect cure, and that too without pain 
to the patient. He is a skillful physician, and one of the best of men. 

From the Louisville Democrat, May 29, 1854. 
W. Bodenhamer, M.D — By reference to the card of Dr. Bodenhamer it will 
be seen that he has adopted New York as his summer quarters, instead of Louis- 
ville as heretofore. He stands unrivalled in his practice. The most inveterate 
cases of fistula in ano, cases which have baffled the skill of the most eminent med- 
ical practitioners in the Union, yield, certainly and safely, to his treatment. Hun- 
dreds of patients who have heretofore sought him during the summer months in 
our city, and in the winter in New Orleans, must now during the warm season 
go to New York to avail themselves of his practice. Dr. Bodenhamer is a gentle- 
man of the old school — too modest to make known the singular success of his 
treatment, and for years even to publish a card. We have yet to hear of a case m 
which he has failed. Our own experience and knowledge prompt us to this 
notice, and we sincerely regret that he has changed his summer quarters. 






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